Veteran Disability Survey

The VVA and VMW filed a lawsuit that focuses on the long delays the Department of Veterans Affairs (VA) forces veterans to endure when applying for the disability benefits they have earned through their service to our country. If you are a veteran who has experienced delays or problems with your disability benefits from the VA, and you are willing to share your story, please complete the following questionnaire. The information we compile will be used to illustrate the real life issues that today's veterans face. Please include your name only if you are comfortable sharing that information.

Name:	City/State where you currently reside:	Age:
Email Address:	Phone Number:
Veterans service organization, if any, of which you are a member (e.g. Veterans of Modern Warfare, Vietnam Veterans of America, etc.)
When did you enter the military (volunteer/draft)?	How old were you when you joined the military?
Where did you enlist?
Why did you enlist?
What service were you in?
What was your job/specialty/function?
Did you see combat? Yes   No
If so, where?	When?
How many tours?
When and under what circumstances did you leave the military?
What was your rank when you left the military?
How did you learn about the VA?
Have you submitted disability claims? Yes   No
If so, for what condition(s)?
When did you file this claim?
How long did you have wait for an in initial response?
Were you initially denied? Yes   No
If so, what was the reason that was given?
Did you appeal the denial? Yes   No
How long did it take for the VA to respond to your appeal?
Do you currently have any outstanding claims with the VA? Yes   No
Are you comfortable sharing your story with the media? Yes   No

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