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Veterans' Disability Case Evaluation

We can evaluate your case if:

You are a disabled Veteran.
You are the family member of a disabled Veteran.
You live in Colorado.

Things to know before you fill out the form:

If you do not live in Colorado visit NOVA and click on "Membership Directory."
It will take approximately 5-10 minutes to complete this form.
No attorney-client relationship is established by submitting this form.
All information you submit to us will be kept confidential.
Fields in red are required.

Title


First Name

Last Name

Street Address

Apt.#

City

State

Zip

You will need to enter either a phone number or e-mail address so that we can contact you.

Phone number

E-mail

Best time of day to reach you

How did you get to us (check all that apply)
Search engine
FindLaw.com
Qwest Yellow Pages
Dexknows.com (Dex Online)
Facebook
LinkedIn
Spencer & Spencer Newsletter
Friend
Client of ours
Link from another site
Other
How old are you?
Branch of the Service (give an approximate date if you are unsure)


Dates Served
to
Are you currently employed?
Yes
Not Since

Type of claim (check all that apply)
Disability
Death Benefits - Your relationship to the deceased
Benefits for my Family Members
Pension Benefits
Other
Have you filed a claim with the VA?: yes no; Date you filed claim
Have you received a rating decision from the VA yet?: yes no; Date of the decision

If yes, what rating have you received?

Why do you disagree with the rating you were given?

Have you filed a Notice of Disagreement?: yes no; Date Notice was filed
If yes, have you had a hearing, or do you have one scheduled?: yes no; Date of hearing; Judge assigned to case

Has your case gone to the Board of Veterans' Appeals?: yes no; Date of BVA decision

Has your case gone to the U.S. Court of Appeals for Veterans' Claims?: yes no; Date of CAVC decision

Please list the medical conditions want rated by the VA

Have any of your doctors told you not to work, or given you work restrictions?
yes no
If yes, please fill in the doctor's name and any restrictions given

Please list all medications you currently take

Please list all doctors who have treated your disabling conditions

How often do you see a doctor?

Please list any surgeries you have had related to your disability(s)

Why did you decide to contact an attorney?

Please give us any additional information that you feel will help us evaluate your case

Security Question:

What letter has the gavel behind it?

If you have access to a fax, you can expedite our review of your case by faxing your most recent decision from the VA to our office at (719) 632-4807.

Hit "Submit" and we will review your case. Someone from our office will contact you.