Case Review

Please answer the questions below. You will receive an initial response immediately. Do not include medical information; only the details requested here are needed.

About you Your full legal name Other names you have used (maiden or former names, nicknames), if any Email Phone

Email or phone is required.

State you live in (optional)

Your decision Which best describes where your case is?

The Board of Veterans' Appeals decided my appeal

I already filed an appeal with the Veterans Court myself

The Veterans Court decided my appeal and I want to appeal further

I got a decision from a VA regional office (not the Board)

VA has not acted on my claim for a long time

Date on the decision (the date it was mailed)

For a Board decision, use the date on the first page. For a Veterans Court decision, use the date of the judgment.

What did the Board do?

Denied all or part of my claim

Only sent my issues back (remanded) - nothing was denied

Not sure

What the appeal is about (check all that apply)

Disability compensation (service connection, rating, effective date, TDIU)

Survivor benefits (DIC) or a claim for a veteran who has died

Pension

Education (GI Bill)

Home loan

Insurance

Vocational rehabilitation (VR&E)

Burial benefits

Character of discharge / eligibility because of discharge

A dispute with another person over benefits (e.g., apportionment)

VA health care eligibility

Something else

A few more questions Does a lawyer or agent already represent you in this appeal?

Yes

Is your total net worth under $2,000,000?

Federal law (the Equal Access to Justice Act) only allows the government to pay my fees for people under this limit.

Yes

Not sure

Would paying the Veterans Court's $50 filing fee be a financial hardship for you?

If so, I can ask the Court to waive it. Either way, you won't pay it.

Yes

To the best of your knowledge, do you owe a past-due debt to the federal government?

For example, a VA overpayment you're paying back, a defaulted federal student loan, or back taxes. The government can take my fee to pay these debts, so I ask up front. A "yes" doesn't mean I can't help.

Yes

Not sure

Are you the veteran?

Yes

Names of anyone else who has claimed, or may claim, these same benefits (for example a spouse, former spouse, or children). Write "none" if there is no one.

I ask only for names, so I can check for conflicts of interest before speaking with you.

Anything else I should know? (optional, no medical details)

Submitting this form does not create an attorney-client relationship. Your answers will be used only to respond to you and to check for conflicts of interest. Do not rely on this form to meet any filing deadline.