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Binder Law Firm

1-800-4-BINDER

Veterans Disability Evaluation

Please fill out our Secure FREE Veterans Disability Evaluation Form.
One of our representatives will contact you within 2 business days.

* indicates required information.

Name:*

Date of Birth*

Email:* (Please enter a valid email address)

Street Address:*

City:*

State:*

ZIP (5 digits)*

Telephone Number:*

Are you currently receiving service-connected disability benefits?*

Yes

No

If applicable, what is your combined rating?* (Enter “0%” if it doesn't apply)

Did you receive an initial decision?*

Yes

No

Did you file a Notice of Disagreement?*

Yes

No

If applicable, Date Notice of Disagreement was filed* (Enter “1/1/1900” if it doesn't apply)

Are you currently working?*

Yes

No

If applicable, Date last worked* (Enter “1/1/1900” if it doesn't apply)

Are you unable to work due to service-connected disability?*

Yes

No

Are you receiving Social Security Disability or Supplemental Security Income benefits?*

Yes

No

Are you receiving non service-connected pension?*

Yes

No

Have you applied for Social Security Disability benefits?*

Yes

No

if yes, what is the status?*

** If you applied, Please send us a copy of the decisions you have immediately to responses@binderlawfirm.com

Tell us about the service connected disabilities you are claiming*
(Maximum length: 500 characters.)

Tell us how you would like us to assist with your claim*
(Maximum length: 500 characters.)

The information you obtain at this site is not, nor is it intended to be, legal advice. We invite you to contact us and welcome your calls, letters and electronic mail. Contacting us via this web at www.binderlawfirm.com is not retaining the law firm. You are not a client until you sign a retainer and the government form 1696 and return them to us. If there are deadlines to file an appeal, DO IT NOW. we cannot file any appeal nor can we act on your behalf until you retain us and authorize us to handle your social security case.


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