Workers' compensation & social security lawyers

Veterans' Disability Case Evaluation

Currently, we only handle cases for Veterans who live in Colorado. If you live in another state and need an attorney, please visit the National Organization of Veterans Advocates and click on "Membership Directory."

You can send this information over the Internet by clicking submit at the bottom of the form. If you are concerned about the privacy of this information, you can fill out the form, print it out and fax it to us at (719) 632-4807. Please note that no attorney-client relationship is established by submitting this form.

We estimate that it will take 10-15 minutes to complete this form.

Fields in red are required.

General Information

 
Last Name
 
 
 
 City
 
 
 

You will need to enter either a phone number or e-mail address so that we can contact you.

 
E-mail
  
 
How did you get to us (check all that apply)
Dex Online
Spencer & Spencer Newsletter
 
  
 
               
 
(give an approximate date if you are unsure)
              
 
to            
 
Are you currently employed?
Yes.
Not Since .
 

Claim Information

Type of claim (check all that apply)
 -
Benefits for my Family Members
 
Have you filed a claim with the VA? 
yes    no
 
 
Have you received a rating decision from the VA yet?
yes   no
 
 
If yes, what rating have you received?
 
Have you filed a Notice of Disagreement?
yes    no
 
    If yes, have you had a hearing, or do you have one scheduled?
yes   no
 
 
 
Has your case gone to the Board of Veterans' Appeals?
yes    no
Has your case gone to the U.S. Court of Appeals for Veterans' Claims?
yes    no

Disability Information

Please list the medical conditions want rated by the VA
 
 
Have any of your doctors told you not to work, or given you work restrictions?
yes   no
 
      If yes, please fill in the doctor's name and any restrictions given

     

 
How often do you see a doctor?
 
 
 

 
After you have filled out the form, a lawyer will review your case, and someone from our office will contact you.
 
You can send this information over the Internet by clicking submit at the bottom of the form. If you are concerned about the privacy of this information, you can fill out the form, print it and fax it to us at: (719) 632-4807.

 


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© 1998-2008 Spencer & Spencer, P.C., Attorneys at Law
830 Tenderfoot Hill Road, Suite 320, Colorado Springs, Colorado 80906

Practice limited to workers' compensation, veteran's disability and social security disability law.