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Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho IllinoisIndiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri MontanaNebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon PennsylvaniaRhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin WyomingLiving Outside of the USWhat is Your Zip Code?Are You Militrary Retired?This means you retired from the military and were NOT medically retired. Select YesNoDo You Receive Military Retirement Pay?This would be your military pension that is NOT related to a pension from being medically retired. Select YesNoDo Have an Active Appeal Pending?Are you currently appealing a past rating decision or denial of service-connection. Select YesNoActive Appeal - Please list all condition assoicated with your claim. Do You Have an Active Claim Pending?Active claims are condittions that are pending a decision. Select YesNoActive Claim - Please list all condition assoicated with your claim. Overall Disability RatingPlease select your current overall service-connected disability rating. This is rating that the VA gave you. Overall Rating--- Select ---Not Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%The VA Rated You 70%The VA Rated You 80%The VA Rated You 90%The VA Rated You 100%Service-Connected DisbilitiesWhat is a Service-Connected Disability? - An injury or illness which was incurred or aggravated during active military service. On your Rating Decision Letter (RDL), the word "Service-Connected" should be displayed next to your medical condition. Check "Yes" for Disabilities That ApplyAnkle Disability YesNoBack Disability YesNoChronic Fatigue SyndromeYesNoDiabetes Disability YesNoElbow Disability YesNoEpilepsy Disability YesNoFibromyalgia Disability YesNoFoot Disability YesNoGERD Disability YesNoHeadache Disability YesNoHeart Disability YesNoHip Disability YesNoIBS Disability YesNoKnee Disability YesNoKidney Disability YesNoNeck Disability YesNoMental Disability YesNoNeuropathy Disability YesNoProstrate Disability YesNoRespiratory Disability YesNoScars Disability YesNoSkin Disability YesNoSinusitis Disability YesNoShoulder DisabilityYesNoSleep Apnea Disability YesNoWrist Disability YesNoOther DisabilityYesNoAnkle DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%Body Side Select RightLeftBothDetailsBack DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%The VA Rated You 70%Lower Body Numbness and Tingling Select Yes - I have numbness and tingling.No- I do not have numbness and tingling. DetailsChronic Fatigue SyndromeDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%DetailsDiabetes DisabilityDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%Details Epilepsy DisabilityDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%DetailsElbow DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%Body Side Select RightLeftBothDetailsFibromyalgia DisabilityDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%DetailsFoot DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%The VA Rated You 70%Body Side Select RightLeft BothDetailsGERD DisabilityDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%DetailsHeadache DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%DetailsHeart DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%DetailsHip DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%Body Side Select RightLeft BothDetailsIrratatable Bowel DiseaseDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%DetailsKnee DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%Body Side Select RightLeftBothDetailsKidney DisabilityDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%DetailsNeck DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%Upper Body Numbness and Tingling Select Yes - I have numbnes and tingling.No - I do not have numbes and tingling.DetailsMental DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%The VA Rated You 70%The VA Rated You 80%The VA Rated You 90%The VA Rated You 100%DetailsNeuropathy Disability Disability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%The VA Rated You 70%The VA Rated You 80%The VA Rated You 90%The VA Rated You 100%DetailsProstrate Disability Disability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%The VA Rated You 70%The VA Rated You 80%The VA Rated You 90%The VA Rated You 100%DetailsRespiratory DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%DetailsScar DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%DetailsSinusitis DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%The VA Rated You 70%The VA Rated You 80%The VA Rated You 90%The VA Rated You 100%DetailsShoulder DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%Body Side Select RightLeftBothDetailsSleep Apnea DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%The VA Rated You 50%The VA Rated You 60%The VA Rated You 70%The VA Rated You 80%The VA Rated You 90%The VA Rated You 100%DetailsWrist DisabilitiesDisability RatingSelectNot Service RelatedThe VA Rated You 0%The VA Rated You 10%The VA Rated You 20%The VA Rated You 30%The VA Rated You 40%Body Side Select RightLeftBothDetailsNon-Listed DisabilitesPlease list any additional disabilities that are not listed above. Only list disabilities that you are service-connected for and your current rating. Additional Disabilities By submitting this form, you have read and agreed to Veteranratings.coms release of information & authorization of disclosure agreement.Submit Information