Va date stamp do not write in this space

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VA DATE STAMP (DO NOT WRITE IN THIS SPACE) …

www.clientservicesnetwork.com

SECTION III: SERVICE PAY SECTION II: SERVICE INFORMATION VA Form 21-2680 or, if based on nursing home attendance, VA Form 21-0779 20A. DID/DO YOU RECEIVE ANY TYPE OF SEPARATION/SEVERANCE/RETIRED PAY?

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(DO NOT WRITE IN THIS SPACE) STATEMENT IN ... …

www.vba.va.gov

STATEMENT IN SUPPORT OF CLAIM VA FORM DEC 2017 21-4138€ OMB Control No. 2900-0075 Respondent Burden: 15 minutes Expiration Date: 12/31/2020 EXISTING STOCKS OF VA FORM 21-4138, JAN 2015,

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INFORMATION AND INSTRUCTIONS FOR …

www.ngwrc.org

There is extra space provided for you in Item 11A to explain why you feel VA incorrectly decided your claim, and to list any disagreements not covered by the form.

Information, Instructions, Space, Information and instructions for

Va date stamp do not write in this space