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(DO NOT WRITE IN THIS SPACE) STATEMENT IN ... …
www.vba.va.govSTATEMENT 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,
VA DATE STAMP (DO NOT WRITE IN THIS SPACE) …
www.clientservicesnetwork.comSECTION 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?