Enter your full legal name exactly as it appears on your DD-214. Include suffix (Jr., Sr., III) if applicable. Even one letter mismatch with VA records will delay your claim at intake.

e.g., John Michael Smith Jr.

• ×Using a nickname or shortened version instead of your legal name on DD-214 - causes intake delays and identity-mismatch flags.
• ×Omitting suffix (Jr., Sr., II, III) when it appears on military records - may route to the wrong VA file.
• ×Hyphenated names entered without the hyphen - VA OCR often fails to match.

Your SSN is how VA finds your file. If you have a separate VA File Number (older veterans, especially pre-1973), include both - VA File Numbers do not always match the SSN.

XXX-XX-XXXX

• ×Entering a transposed SSN - re-check digit by digit. Wrong SSN sends the claim to a stranger's file.
• ×Leaving VA File Number blank when you actually have one - older veterans get routed to the wrong jacket.

Date of birth as shown on official records (DD-214 typically reflects this). Mismatch causes intake holds.

MM/DD/YYYY

• ×Day/month transposition (especially veterans who served abroad and use DD/MM/YYYY format) - VA expects US MM/DD/YYYY.

The address VA will mail decision letters and ratings to. If you move during the claim, you must update via VA Form 20-572 immediately or you may miss critical correspondence (including C&P exam scheduling notices).

Street, City, State, ZIP

• ×Using a temporary/forwarding address - missed C&P exam notices = denial without your input.
• ×Listing only a PO Box when VA needs a physical address for some processes (e.g., home-loan certifications) - provide both if possible.

A reliable phone and email. C&P exam vendors call this number to schedule your exam - missing the call delays the claim by weeks. VA email correspondence is opt-in via VA.gov.

(555) 555-5555 / email@example.com

• ×Listing a number you screen aggressively - exam vendors give up after 2-3 missed calls and the claim stalls.
• ×Using a work email that may be revoked - VA notifications are time-sensitive.

Your branch (Army, Navy, Marines, Air Force, Space Force, Coast Guard, NOAA Commissioned Corps, USPHS Commissioned Corps). If you served in multiple branches, list each with separate dates. Reservist/Guard service is reported under "Reserve/Guard component" if separate from active.

e.g., United States Army

• ×Listing branch nickname ("Marines") when official format is "United States Marine Corps" - VA prefers official format.
• ×Forgetting prior reserve/guard time that converted to active duty - verify against every DD-214 you hold.

Exact dates from DD-214 Block 12 ("Record of Service" - entry date and separation date). Include every period of service. Title 10 active duty and Title 32 federalized Guard/Reserve time both count for compensation.

e.g., 03/15/2005 to 09/20/2012

• ×Reporting the date you signed your enlistment contract instead of the date your DD-214 says you went on active duty - they often differ by months.
• ×Omitting periods of inactive duty for training (IDT) that shouldn't be there, or omitting active duty for training (ADT) that should - read DD-214 Block 12 carefully.
• ×Forgetting Reserve/Guard mobilization periods that triggered Title 10 active orders.

Pre-1969 (Army), pre-1972 (Navy/Marine Corps), pre-1969 (Air Force), pre-1974 (Coast Guard) veterans were issued a service number that is not their SSN. Most post-1973 veterans can leave this blank.

Enter if applicable

• ×Older veterans entering SSN here when DOD records still index them under the original service number - slows VA-NPRC record requests.

List EVERY condition, one per line. Be specific (medical terminology when possible) and tag each as one of: NEW (initial claim), INCREASE (already rated, getting worse), SECONDARY (caused or aggravated by an already service-connected condition), or PRESUMPTIVE (PACT Act, Agent Orange, Camp Lejeune, Gulf War, ionizing radiation). Anything not listed here will not be considered - even if it's in your medical records.

e.g.,
1. Lumbar degenerative disc disease (NEW)
2. Left knee patellofemoral syndrome (INCREASE - currently rated 10%)
3. Radiculopathy, left lower extremity (SECONDARY to lumbar DDD)
4. Sleep apnea (SECONDARY to PTSD)
5. Hypertension (PRESUMPTIVE - PACT Act, Vietnam-era AO)

• ×Lumping unrelated conditions in one line - every condition must be claimed separately or VA will treat them as one issue.
• ×Using vague terms like "back pain" instead of specific diagnoses ("lumbar degenerative disc disease, L4-L5") - vague claims get vague ratings or denials.
• ×Forgetting to tag each condition as NEW / INCREASE / SECONDARY / PRESUMPTIVE - VA may misroute the claim and deny on the wrong theory.
• ×Omitting conditions because you "don't want to seem greedy" - anything not listed here will not be considered, period.
• ×Not claiming secondary conditions (e.g., depression secondary to chronic pain, sleep apnea secondary to PTSD) - Allen v. Brown allows aggravation theory; you leave benefits on the table by skipping these.

For each condition listed: when did symptoms first appear (NEW), when did the rated condition get worse (INCREASE), or when did the secondary condition emerge (SECONDARY)? In-service dates are strongest evidence. If you cannot recall exact dates, estimate to the nearest month/year and explain why.

e.g.,
1. Lumbar DDD: approx. June 2008 (during deployment to Iraq, after IED blast)
2. Left knee: gradual worsening since 2019; severe by 2024
3. Radiculopathy: emerged Feb 2023, post lumbar MRI showing nerve impingement

• ×Saying "I don't remember" when an estimate would do - even an approximate month/year is enough for the VA to develop the claim.
• ×Reporting onset as the date you got diagnosed rather than the date symptoms started - diagnosis date and onset date are different and rating periods depend on it.
• ×For increase claims: not specifying when the condition got worse - VA will assume the increase began at the date you filed, costing you back pay.

For each condition: how is it connected to your military service? Was it caused by a specific event, exposure, repeated activity, or duty environment? For SECONDARY claims, name the primary service-connected condition that caused or aggravated it. For PRESUMPTIVE claims, name the exposure/program (Agent Orange, PACT Act burn pits, Camp Lejeune water, Gulf War undiagnosed illness).

e.g.,
1. Lumbar DDD: caused by repeated heavy lifting and 60+ lb rucksack marches during infantry duties 2005-2012; aggravated by IED blast injury 2008.
2. Radiculopathy: secondary to service-connected lumbar DDD per 38 CFR 3.310.
3. Hypertension: presumptive under PACT Act 38 CFR 3.320, exposed to burn pits at Bagram Airfield 2008-2009.

• ×Vague service-connection language ("happened in the military") - name the specific event, exposure, or repeated activity.
• ×For secondary claims, not naming the primary service-connected condition - VA can't connect them without the chain explicit.
• ×Assuming presumptive conditions speak for themselves - even presumptives need the location/program documented (deployment to Vietnam, residence at Lejeune, etc.).
• ×Using opinion language ("I think it's from...") instead of factual language ("Caused by..., evidenced by...") - facts move claims.

List EVERY provider - VA medical centers, civilian doctors, hospitals, chiropractors, mental health providers - that has treated any condition you are claiming. VA will request VA records automatically; for civilian/private records you must complete VA Form 21-4142 (and 21-4142a for the provider list).

e.g.,
VA Medical Center, Phoenix AZ - 2013 to present (all conditions)
Dr. Jane Smith, Orthopedics, 123 Main St, Tempe AZ - Jan 2019 to present (lumbar DDD, knee)
Dr. Carlos Lopez, Mental Health, Phoenix AZ - Feb 2020 to present (PTSD, depression)

• ×Forgetting to file 21-4142 + 21-4142a authorizations for civilian providers - VA can't request the records without your signed release.
• ×Listing only VA providers when civilian records contain critical evidence - if your civilian doctor diagnosed it first, those records may be your strongest evidence.
• ×Vague date ranges - "for years" doesn't help VA pull the right time window. Use month/year.

List every piece of evidence you are submitting WITH this form. Attach copies (never originals). VA also gives you 1 year from the rating decision to submit additional evidence under the Decision Review Request: Supplemental Claim track if anything is missing now.

e.g.,
- Doctor summary from Dr. Smith re: lumbar DDD nexus (attached, 3 pages)
- Buddy statement from SGT Jones (attached, VA Form 21-10210)
- Private orthopedic records 2019-2024 (attached, 47 pages)
- DBQ - Back conditions, completed by Dr. Smith Jan 2026 (attached)

• ×Submitting originals instead of copies - VA will not return them.
• ×Failing to label each attachment - examiners can't cross-reference unlabeled evidence to specific conditions.
• ×Submitting evidence without checking that it actually supports a 38 CFR Part 4 rating criterion - irrelevant evidence dilutes your strong evidence.

Anything else VA should know. Use this space for: PACT Act eligibility statement, presumptive program election, request for expedited processing (terminal illness, financial hardship, age 85+, MoH, ex-POW), request for a specific C&P examiner specialty, IDES enrollment status, or anything that doesn't fit elsewhere.

e.g., I served in Bagram, Afghanistan from June 2008 to May 2009 and was exposed to burn pits. I am claiming hypertension and asthma as presumptive under the PACT Act, 38 CFR 3.320. I request a C&P exam by a board-certified pulmonologist for the asthma claim due to its complexity.

• ×Asking for things VA can't give (e.g., guaranteed back-pay amount) - keep it factual.
• ×Repeating information already in other blocks - wastes VA reviewer attention.
• ×Adding a presumptive program claim without the underlying location/exposure documented - claim will be denied as "no evidence of exposure."