Appendix H

Blank Forms

This is a listing of all of the Forms you might need in your quest for a PTSD Disability. Simply go to the Web Page listed, download the Form (Probably in PDF Format), and print the number of copies you will need.

Standard Forms

SF 180 (Request Pertaining to Military Records) - 3 Pages

Veterans Administration Forms

VA 1-646 (Statement of Accredited Representation in Appealed Case) - 2 Page

VA 9 (Appeal to Board of Veterans’ Appeals) - 5 Pages

VA 10-10EZ (Application for Health Benefits) – 5 Pages

VA 10-5345 (Request for and consent to Release of Medical Records.) - 2 Page

VA 21-526 (Veterans Application for Compensation or Pension) – 23 Pages

VA 21-527 (Income-Net Worth and Employment Statement) - 10 Pages

VA 21-4142 (Authorization for Release of Information) – 2 Pages

VA 22a (Appointment of Attorney or Agent as Claimant’s Representative) - 1 Page

VA 28-1901 (Counseling Record – Personal Information) – 2 pages

VA 28-8872 (Rehabilitation Plan) – 2 Pages

VA 0220 (Notice of Appellate Rights Following Denial of Motion For Reconsideration) - 1 Page

VA 4107 (Your Rights to Appeal our Decision) – 2 Pages

VA 4597 (Board of Veteran’s Appeals notice) - 2 Page

Find Forms at My homepage = WWW.PTSD.Com/Apph.htm

Find Forms at the VA Homepage = WWW.VA.GOV/vaforms/

Find a ADOBE reader at = WWW. Adobe.com/products/acrobat/readstep2.html