Tell Us More About Your Disabilities

To help our team be ready to give you a FREE consultation please provide us with some more information on your service-connected disability. If you prefer to speak with our team members then you may close this page and we will be in touch soon. We look forward to speaking with you.

Please Complete the Form Below!

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Overall Disability Rating

Please select your current overall service-connected disability rating. This is a rating that the VA gave you for your condition(s).

Service-Connected Disbilities

What is a Service-Connected Disability? - An injury or illness that the VA awarded a rating, which incurred or aggravated during active military service. Skip any questions that do not apply to you.

Ankle Disabilities

Do you have a service-connected disability for your ankle(s)? If so, please tell us your rating and which side of the body it relates to.

Back Disabilities

Do you have a service-connected disability for your back? If so, please tell us your rating and which side of the body it relates to.

Chronic Fatigue Syndrome

Do you have a service-connected disability for Chronic Fatigue Syndrome? If so, please tell us your rating.

Diabetes Disability

Do you have a service-connected disability for diabetes? If so, please tell us your rating.

Epilepsy Disability

Do you have a service-connected disability for Epilepsy? If so, please tell us your rating.

Elbow Disabilities

Do you have a service-connected disability for your elbow(s)? If so, please tell us your rating and which side of the body it relates to.

Fibromyalgia Disability

Do you have a service-connected disability for Fibromyalgia? If so, please tell us your rating.

Foot Disabilities

Do you have a service-connected disability for your feet? If so, please tell us your rating and which side of the body it relates to.

GERD Disability

Do you have a service-connected disability for GERD? If so, please tell us your rating.

Headache Disabilities

Do you have a service-connected disability for your headaches? If so, please tell us your rating and which side of the body it relates to.

Heart Disabilities

Do you have a service-connected disability for your heart? If so, please tell us your rating and which side of the body it relates to.

Hip Disabilities

Do you have a service-connected disability for your hip(s)? If so, please tell us your rating and which side of the body it relates to.

Irratatable Bowel Disease

Do you have a service-connected disability for IBS? If so, please tell us your rating.

Hip Disabilities

Do you have a service-connected disability for your knee(s)? If so, please tell us your rating and which side of the body it relates to.

Kidney Disability

Do you have a service-connected disability for Kidney? If so, please tell us your rating.

Neck Disabilities

Do you have a service-connected disability for your neck? If so, please tell us your rating and if your upper or lower extremities are affected by your disability.

Mental Disabilities

Do you have a service-connected disability for any mental conditions? This includes anxiety, PTSD, and depression. If so, please tell us your rating.

Neuropathy Disability

Do you have service-connected Neuropathy disabilities? If so, please tell us your rating.

Prostate Disability

Do you have service-connected prostate disabilities? If so, please tell us your rating.

Respiratory Disabilities

Do you have service-connected respiratory disabilities? If so, please tell us your rating.

Scar Disabilities

Do you have service-connected scar disabilities? If so, please tell us your rating.

Sinusitis Disabilities

Do you have service-connected sinusitis disabilities? If so, please tell us your rating.

Shoulder Disabilities

Do you have a service-connected disability for your shoulder(s)? If so, please tell us your rating and which side of the body it relates to.

Sleep Apnea Disabilities

Do you have a service-connected disability for sleep apnea? If so, please tell us your rating.

Wrist Disabilities

Do you have a service-connected disability for your wrist(s)? If so, please tell us your rating and which side of the body it relates to.

Non-Listed Disabilities

Please list any additional disabilities that are not listed above. Only list disabilities that you are service-connected for and your current rating.
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