Colorado Springs

Toll-Free in Colorado
719-632-4808
800-975-8367
Veterans' Disability Case Evaluation
SiteLock We can evaluate your case if:
  • You have a claim for TDIU/unemployability, death benefits, pension, or are seeking an increased rating or service connection for a mental illness.
  • You live in Colorado. If not , please visit NOVA's Membership Directory to find an attorney.
Things to know before you fill out the form:
  • If you don't live in Colorado, we cannot help with your claim. Instead, go to NOVA's Membership Directory.
  • It will take about 10-15 minutes to complete this form, and the information you send us is confidential.
  • No attorney-client relationship is established by submitting this form.
*Required fields.
Preliminary Information
Does your case involve any of the following types of claims?*

We're currently only taking cases where you need help with: 1) TDIU (unemployability), 2) service-connection or increases in mental illnesses, 3) pension, or 4)death claims. If you're seeking help with a type of claim that isn't listed, you will need to contact other attorneys. You can find other attorneys at: Dept of VA and NOVA.
Contact Information
Title:*
First name:*
Last name:*
Address:
City:*
State:*   If you don't live in CO, you will need to  find a VA attorney near you.
Zip:
Daytime phone:*
Mobile phone:
E-mail address:*
Referral Source
How did you find us?

 Please check all that apply:
Saw ad in the phone book
Search engine
Findlaw.com
Dexknows.com (Dex Online)
Better Business Bureau (BBB)
Facebook
LinkedIn
Client of ours
Other
General Information
How old are you?
Are you currently employed?* Yes No, not since: (mm/yyyy)
Your Military Service
Branch of the service:* Army
Air Force
Navy
Marines
Coast Guard
Dates served: Army

Air Force

Navy

Marines

Coast Guard
Did you receive a Military Medical Board Rating?* Yes No
If yes, what rating did you receive? %
Your VA Disability Claim
Have you filed a claim with the VA?* Yes No
Date you filed the claim:  (mm/yyyy)
Type of benefits you applied for (check all that apply):* Disability
Benefits for my dependents
Pension benefits
Death benefits - Your relationship to the deceased:
Have you received a Rating Decision or Statement of the Case (SOC) from the VA?* I received a Rating Decision
I received a Statement of the Case (SOC)
No Rating Decision or SOC received yet
Date of your most recent decision or SOC:

What overall rating-percentage did you get? %
(If you have more than one rating decision or SOC, please note that in the additional information field at the bottom.)
Please provide information about your 5 most disabling conditions:* 1. Your first disabling condition:
Are you service-connected for this condition? Yes No
VA rating: %
Do you disagree with this rating? If so, why?

 
2. Your second disabling condition:
Are you service-connected for this condition? Yes No
VA rating: %
Do you disagree with this rating? If so, why?
3. Your third disabling condition:
Are you service-connected for this condition? Yes No
VA rating: %
Do you disagree with this rating? If so, why?
4. Your fourth disabling condition:
Are you service-connected for this condition? Yes No
VA rating: %
Do you disagree with this rating? If so, why?
5. Your fifth disabling condition:
Are you service-connected for this condition? Yes No
VA rating: %
Do you disagree with this rating? If so, why?
Have you filed a Notice of Disagreement? Yes No
Date NOD was filed:  (mm/dd/yyyy)
Have you requested a hearing (filed a VA
Form-9)? See a VA Form-9		 Yes No
Date Form-9 was filed:  (mm/dd/yyyy)

If a Form-9 was filed, have you had a hearing, or do you have one scheduled?
Have one scheduled Had a hearing
Date of the hearing:  (mm/dd/yyyy)
Date of the BVA decision:  (mm/dd/yyyy)
Has your case gone to the U.S. Court of Appeals for Veterans Claims (CAVC)? Yes No
Date of CAVC decision: (mm/dd/yyyy)
About Your Disability
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 the medications you take for your disabling conditions:
Please list the doctors who treat you for your disabling conditions:
How often do you see a doctor?
Please list any surgeries you have had related to your disabilities:
Additional Information
Why did you decide to contact an attorney?
Please give us any additional information that you feel will help us better evaluate your case:
Security Question
Security Code: Security Code
Please enter the security code you see above:   

It may take a few minutes for the form data to go through.
Please do not hit the button more than once.