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VA 21-0958 2015 free printable template

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Reginfo. gov/public/do/PRAMain. If desired you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form. VA FORM 21-0958 JAN 2015 OMB Approved No. 2900-0791 Expiration Date 9/30/2017 NOTICE OF DISAGREEMENT A CLAIMANT OR HIS OR HER DULY APPOINTED REPRESENTATIVE MAY FILE NOTICE EXPRESSING THEIR DISSATISFACTION OR DISAGREEMENT WITH AN ADJUDICATIVE DETERMINATION BY THE AGENCY OF ORIGINAL JURISDICTION. A DESIRE TO CONTEST THE RESULT WILL CONSTITUTE A...
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How to fill out va form 21 0958

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How to fill out VA 21-0958

01
Obtain the VA Form 21-0958 from the VA's website or your local VA office.
02
Fill out your personal information in the designated sections, including your name, Social Security number, and contact information.
03
Clearly state the reason for your intent to appeal the VA's decision.
04
Provide any necessary details or evidence that supports your appeal.
05
Sign and date the form at the designated line.
06
Submit the completed form to the appropriate VA office, either by mail or electronically, as specified in the instructions.

Who needs VA 21-0958?

01
Veterans who disagree with a decision made by the Department of Veterans Affairs regarding their benefits or claims.
02
Survivors of veterans who are filing an appeal on behalf of the deceased veteran.
03
Any individual who wishes to formally initiate an appeal process concerning VA decisions.

Who needs VA Form 21-0958?

Every veteran who has a need to appeal from a decision concerning his claim for disability compensation should use this form as far as it is the only way express your disagreement.

What is VA Form 21-0958 Used For?

VA Form 21-0958 is a Notice of Disagreement. Whenever you disagree with some statement or decision regarding your claim for disability compensation made by your Regional Office, you should use this form to indicate your disagreement. In fact this form is the only way to initiate an appeal from a decision described above.

Is VA Form 21-0958 Accompanied by Other Forms?

This form doesn’t require any other forms to accompany it. However, you may add some extra sheets if you lack space while filling in the last field. You also should attach any materials that support and explain your Note of Disagreement.

What Information should be Provided in VA Form 21-0958?

While filling out VA Form 21-0958 you should mention the following information:

  • Veteran’s name

  • Veteran’s social security number

  • Claimant’s name

  • Mailing address

  • Telephone contacts

For each issue:

  • Specific issues of disagreement

  • Area of disagreement 

  • Percentage Evaluation Sought (if known)

After filling out the form you should provide a signature on the bottom of it. Otherwise, you will get it back to be signed. This will make the processing of your form much longer.

Where do I Send VA Form 21-0958?

You should send or take VA Form 21-095 to the Regional Office that issued the decision, statement or notification you disagree with.  

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People Also Ask about

This form is used by the veteran/claimant or someone writing on your behalf to gather lay or witness statements that support an existing claim for benefits or service.
VA Form 21-2680 is a form, filled out by a medical doctor, to support a claim for aid and attendance and/or housebound benefits filed with the Department of Veterans Affairs.
In order for us to begin processing your NOD, you must complete, sign, and return VA Form 21-0958, Notice of Disagreement, within one year of the date of the decision notice we sent you on the decision(s) you are intending to appeal, or within 60 days from the date of this notice, whichever is later.
Use VA Form 21P-534 if you prefer to provide evidence at a later time to support your claim. You can use this form if you're a surviving spouse or child of a Veteran who has died and want to begin the process of applying for VA benefits or money that we owe the Veteran but did not pay prior to his or her death.
The veteran must sign the form before submitting it. Create a Va Form 21 0845 in minutes with our professional document builder.

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VA Form 21-0958 is a form used by veterans and service members to appeal claims decisions made by the Department of Veterans Affairs (VA).
Veterans, service members, and their authorized representatives are required to file VA Form 21-0958 to appeal a VA decision regarding benefits.
To fill out VA Form 21-0958, provide your personal information, details of the decision you are appealing, the specific issues you are appealing, and any additional evidence or statements you wish to submit to support your appeal.
The purpose of VA Form 21-0958 is to formally notify the VA of a veteran's intent to appeal a decision regarding their benefits, allowing them to initiate the appeals process.
The form requires information such as the veteran's name, claim number, the date of the decision being appealed, the specific issues being contested, and any supporting evidence or reasons for the appeal.
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