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VA Programs Request for Additional Services Please fax to: 1-855-300-1705 Requesting Provider Name: NPI: Requesting Contact Name: Requesting Phone Number: Veteran Name SSN (last four digits) DOB Current.

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Related content

(Separate Form for Each Service Requested)...
COMMUNITY CARE PROVIDER - REQUEST FOR SERVICE ... Note: Requests are approved/denied at VA...
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VA Form 22-5495 - Veterans Benefits Administration
See Information and Instructions on Page 4 for more information. ... use VA Form 22-1995...
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U.S. Department of Veterans Affairs: Graphic...
consistent identity to further shape the way Veterans, their families, and other...
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Related links form

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ing to VA, 81% of veterans filing supplemental claims receive some form of monetary aid. Additionally, 10% of veterans filing the claim have a disability rating of 100%, which means they can receive at least $2,800 every month.

To file a supplemental claim as part of a VA decision review, you'll need to fill out VA form 20-0995. This form is available online via the VA's website. You can submit the form either by mail or in person at your regional VA office. VA form 20-0995 is the application to file a supplemental claim.

When to use this form. Use VA Form 21-4138 when you want to submit a VA “buddy statement” or other statement from someone with firsthand knowledge of information you believe will help support your request for VA benefits.

Use VA Form 20-0995 if you disagree with a VA decision and want to provide new evidence to support your claim.

Understanding VA Supplemental Claim Effective Date Disabled veterans waiting for case decisions are eligible for VA supplemental claim back pay, also called retroactive benefits. This occurs when the VA owes benefits that have accrued since the claimant's effective date.

If you received a decision from a local VA office or a higher-level adjudicator with which you disagree, and you would like one or more issues to be decided by a Veterans Law Judge, you must fill out and submit a VA Form 10182.

Use VA Form 21-4142 to give us permission to obtain your personal information from a non-VA source like a private doctor or hospital. Examples of personal information may include your medical treatment, hospitalizations, psychotherapy, or outpatient care.

Use this form to request a SUPPLEMENTAL CLAIM of the decision you received that you disagree with. A SUPPLEMENTAL CLAIM is a new review of an issue(s) previously decided by the Department of Veterans Affairs (VA) based on submission of new and relevant evidence.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232