Your legal name
Exactly as it appears on your DD-214 or Social Security card — not a nickname. A mismatch is one of the most common reasons a claim gets kicked back.

If you've legally changed your name since service, enter your current legal name — we'll handle the prior-name paperwork with you.

Date of birth & SSN
The VA uses these to locate your service and medical records. Your date of birth is required. Your SSN is optional here — but the VA needs it or your file number on every form, so giving it now saves us from chasing you for it later.
Your SSN is encrypted the moment it leaves this page and is stored separately from the rest of your file. It is never emailed, never texted, and never used for anything except completing your VA forms. Check it carefully — it is how the VA identifies you, and a single wrong digit can stall a claim for months. We show it back to you in full on the review screen for exactly that reason.

If you enter it, use all nine digits. Prefer not to put it here? Leave it blank — your claims specialist will collect it another way, and your claim is not held up either way.

Your mailing address
Where the VA should send decisions and correspondence. Use an address where you reliably get mail.
Housing situation *

The VA prioritizes claims from veterans who are homeless or at risk. Answering honestly can move your claim up the queue — it will never count against you.

If mail is unreliable right now, tell us how to reach you and we'll use that instead.

How we reach you
This is where your completed claim package and status updates go.

Your secure invitation keeps this intake linked to your existing contact. If you change your email, we keep both addresses on that contact. The new address needs verification before it can receive sensitive messages or be used to sign in.

Your documents
Start with your VA decision letters — they’re the most important documents. We’ll pull out the conditions for you to choose from. Medical records are optional. You can keep answering while we read them, or continue without documents.
VA decision letters
Add decision letters
Any past VA rating decision, denial, or award letter.
Required for a supplemental claim.
Tap to choose files, or drag them here.
Official service records
Add service records
DD-214, personnel records, orders, evaluations, or other official service documents.
Tap to choose files, or drag them here.
Medical records & other evidence (optional)
Add medical records
Optional: treatment notes, test results, nexus letters, and buddy statements. You can send these later.
Tap to choose files, or drag them here.

PDF, JPG, PNG, HEIC, DOC, or DOCX · up to 25 MB per file · up to 20 files. Photos of paper documents are fine as long as the text is readable.

You can continue without uploading documents and send them to us later.

Filing a Supplemental? We need your VA decision letters. They let us confirm your documents line up with your current claim status, which is what cuts down the back-and-forth with the VA. Only filing a new claim? Then they're optional. Don't have them handy? Reply to your confirmation email as soon as you can.

Medical records and other evidence are optional and can follow later — just reply to your intake confirmation email.

We’ll extract decision dates and prior outcomes from your uploaded VA letters. Our team reviews any missing or unclear details.

Your service history
Your DD-214 has almost all of this. Every period you served counts — not just the most recent one.
Branch
Which branch or branches did you serve in? *
Most Recent Period Of Active Service

Close is better than blank. If you're not certain of the exact day, use the first of the month — we'll confirm against your DD-214.

The base or installation you separated from — your DD-214 lists the separating station. City and state is enough.

Other Periods Of Service

Served more than once — Active then Guard, or a break in service? Add each period. Skip this if you only served the one period above.

Names And Locations
Did you serve under another name? *

This matters when your service records are filed under a different name than the one you use now.

Every other name you served under
Did you serve in a combat zone after September 11, 2001? *

Answer yes if you were there — even if none of the conditions you're claiming are combat-related. This is about where you served, not what you're claiming.

Approximately when did you serve in the combat zone? These dates are separate from any additional enlistment or service period.

Guard, Reserve & Activation
Are you currently serving, or have you ever served, in the Reserves or National Guard? *

Answer yes if you ever served in the Guard or Reserve — even if you're not claiming anything from that period. The VA uses this to know which service records to request, so a "no" here can stop them pulling records that would help you.

Which one?
Obligation term of service

Your contracted obligation — this is separate from any active-duty dates you gave above.

Current or last assigned unit

If you don't have these to hand, leave them blank — we'll ask again only if the VA needs them.

Are you currently receiving inactive-duty training pay? *
Are you currently activated on federal orders? *

An approximate anticipated separation date is fine.

Prisoner Of War
Have you ever been a prisoner of war? *
Each period of confinement
Toxic exposure during service
Some conditions become presumptive when you served somewhere the VA already recognises — meaning they don't make you prove the cause. It's worth a couple of minutes even if you're unsure.
Are you claiming any disability or symptoms that you believe may be related to a toxic exposure during military service? *

If you're not sure, say so. We'll look at it with you rather than guessing — and we will never mark "No" on your behalf.

We'll review this with you. Your VA form will not say "No" while this is unresolved. Tell us whatever you remember below — a place, a job, a smell, a rumour on base. Partial memory is genuinely useful here.

You can still fill in the checklists below if any of them look familiar. They're optional while your answer is "not sure".

Hazardous Locations

Select every place you served. Leave them all unchecked if none apply.

Agent Orange & Other Herbicides

Select every one that applies to your service.

Other Substances & Hazards

Select every one that applies. You'll add where and when for each.

Where and when you were exposed

One entry per place or period. Add as many as you need — approximate months and years are fine.

What would you like help with?
Add new conditions, choose conditions from your letters, or both.

Add new conditions

Anything you want to claim or discuss, even if it is not in your letters. Plain words like “back pain” are fine.

Your conditions

Review the selected conditions. Use “History only” to leave one out, or “Ask the team” if you are unsure.

Next, tell us more about the conditions you want help with and any treatment.

Tell us about your conditions
One condition at a time. Tell us what you experience in your own words; approximate dates are fine.

“I don’t know” is a valid answer. Leave optional details blank if you are unsure.

The traumatic event
This is the hardest section, and we've kept it to what the VA actually requires. You do not need to relive the detail — a few plain sentences is enough. If you would rather tell a person than type it, call us and we'll take it that way instead.
What type of in-service traumatic event occurred? Select every one that applies. *
What Happened

The VA form takes up to three events. Give us the ones most connected to your claim.

Private VA Health Notification Choice
Are you currently enrolled or registered in VHA health care?
Do you consent to VBA notifying VHA about upcoming claim-related events?

This sensitive choice stays in your private canonical Intake. It is not projected to email, Slack, or a free-text CRM summary.

Changes After The Event

The VA looks for changes in behaviour around the time of the event, because they corroborate it when no report was ever filed. Select any that happened. There is no wrong answer here.

Was A Report Filed?
Was an official report filed? *

Most are never reported. Answering no does not weaken your claim — it changes which evidence we build.

What kind of report?
Possible Evidence

Anyone or anything that might confirm what happened, or that you were different afterwards. Select any that might exist — we do the chasing.

Treatment For The Effects
Did you receive treatment related to the impact of the traumatic event? *
Which of your saved providers treated this?

These are the providers you already gave us. Tick the ones connected to this event — nothing needs re-entering.

Review & submit
Check every line. This is what goes on your VA forms — a typo here becomes a typo the VA has to reconcile. Use Edit on any section; you'll come straight back to this spot.

Questions before you submit? Call 1 530-426-2509. See our privacy policy and data security policy.