Was the decision you are appealing issued BEFORE February 19, 2019? If YES, you may use this form. If NO (decision after 2/19/2019), STOP and use VA Form 10182 (Board Appeal) under the AMA system instead. Filing 21-0958 on a post-AMA decision will be rejected.

Confirm decision date is before 2/19/2019

• ×Filing 21-0958 on a post-AMA decision - rejected. Use 10182 instead.
• ×Confusing the two systems - legacy uses NOD then SOC then Form 9; AMA uses three lanes.

Match exactly to your VA records as they appear on every prior letter or DD-214 - any mismatch causes intake delays.

(use legal name from DD-214)

• ×Mismatched name/SSN.

List each issue with condition + decision (denied or under-rated at X%). Issues not listed here are NOT appealed.

e.g., Lumbar DDD - DENIED 03/15/2018 - disagree.

• ×Forgetting to list an issue - not appealed.

Many legacy appellants benefit from opting into the AMA system - the new system is faster on average. Opting in means filing 10182 (Board) or 20-0995 (Supplemental) or 20-0996 (HLR) instead. One-way decision; no going back to legacy.

Stay in legacy / Opt into AMA

• ×Opting in without reviewing whether legacy or AMA is faster for your specific posture - consult VSO before deciding.

Sign and date. By signing you certify the statements are true to the best of your knowledge under penalty of perjury.

(signature/date when filing)

• ×Forgetting to sign.