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U.S. DOD Form dod-va-21-4165 OMB Approved No. 2900-0095 Respondent Burden: 30 minutes 1. VA FILE NUMBER PENSION CLAIM QUESTIONNAIRE FOR FARM INCOME C/SS- PRIVACY ACT INFORMATION: No allowance of pension
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How to fill out us dod form dod-va-21-4165:

01
Start by entering your personal information in the designated fields. This includes your name, social security number, contact information, and any other required details.
02
Next, provide the details of the veteran for whom you are filing the form. This includes their name, social security number, and any other pertinent information.
03
Proceed to Section I of the form, where you will provide information about the veteran's medical condition. This includes details about their diagnosis, treatment, and any medications they are currently taking.
04
In Section II, you will be required to answer a series of questions pertaining to the veteran's eligibility for benefits. Carefully read each question and provide accurate responses based on the veteran's circumstances.
05
If the veteran has an attorney or representative assisting with their claim, you will need to provide their contact information in Section III.
06
In Section IV, you may be required to provide additional documents or evidence to support the veteran's claim. Make sure to attach any relevant medical records, letters from healthcare providers, or other supporting documents as requested.
07
Once you have completed all sections of the form, review your responses to ensure accuracy and completeness. Make any necessary corrections or additions.
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Finally, sign and date the form to certify that the information provided is true and accurate to the best of your knowledge.

Who needs us dod form dod-va-21-4165?

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The us dod form dod-va-21-4165 is typically required for someone who is applying for disability benefits from the Department of Veterans Affairs (VA).
02
It may be necessary for veterans who are seeking compensation for service-connected disabilities or individuals who are applying for benefits on behalf of a veteran.
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This form is also used by attorneys or representatives assisting veterans with their claims.
Note: It is always recommended to consult with a VA representative or legal professional familiar with the application process to ensure accurate completion of the form and proper submission.
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The form dod-va-21-4165 is the Department of Defense (DoD) and Department of Veterans Affairs (VA) Joint Disability Evaluation Board (JDEB) Election Form. It is used by veterans and service members to elect whether to receive retirement pay or VA disability compensation.
Service members and veterans who are going through the Disability Evaluation System (DES) and are eligible for both military retirement pay and VA disability compensation are required to file the form dod-va-21-4165.
To fill out the form dod-va-21-4165, you need to provide your personal information, including your name, Social Security number, contact information, and military service details. You will also need to make an election on whether you want to receive military retirement pay or VA disability compensation.
The purpose of the form dod-va-21-4165 is to allow service members and veterans to make an election regarding their benefits. It helps determine whether they want to receive retirement pay or VA disability compensation during the Disability Evaluation System (DES) process.
The form dod-va-21-4165 requires you to report your personal information, such as your name, Social Security number, contact information, and military service details. Additionally, you must indicate your election regarding whether to receive military retirement pay or VA disability compensation.
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