589th Member's Input

589th Engineer Battalion Assn

589th Members Only Please

In an effort to help other 589th Members receive VA Medical Benefits and VA Claims, we are asking ALL of our Members to please complete the questionnaire below.

If you are not receiving VA Medical Benefits or have not filed a Disability Claim please answer the first few questions as well.

Our intent is to help those that need VA Medical Coverage receive it and also to help other members win VA Disability Claims that deserve them by sharing the methods of those that have received Claims and for which condition they received their disability.

We will keep as much of your information as you wish confidential and will not post anything to our website that includes your name. We would however like to make available to others the number of members for instance that have filed for an Agent Orange related Heart Condition etc. and which methods worked best in receiving a claim.

Your 589th Brothers thank you for your support!

589th VA Medical Health Care and Disability Claim Questionnaire

Denotes Required Field: *

Last Name: *

First Name: *

Company:

HHC
A Co.
B Co.
C Co.
D Co.
Other

Are You Receiving VA Medical Health Care Benefits?

Yes
No

If Not, Do You Need VA Medical Health Care Benefits?

Yes
No

Have You Ever Filed a VA Disability Claim?

Yes
No

What Year Did You File or Appeal Your Claim?

Select all the Years You Filed

Select all the Years You Appealed

What Did You File a Claim For?

Agent Orange Related Claims Filed
Neuropathy	Amyloidosis
Chloracne	Chronic B-Cell/CCL Leukemias
Diabetes Mellitus (Type 2)	Hodgkin's Disease
Ischemic Heart Disease	Multiple Myeloma
Non-Hodgkin's Lymphoma	Parkinson's Disease
Porphyria Cutanea Tarda	Prostate Cancer
Respiratory Cancers	Soft Tissue Sarcoma

Non-Agent Orange Related Claims Filed
PTSD	Gunshot/Shrapnel Wound
Loss of Appendage	Hearing Loss/Tinnitus
Eyesight Loss	Back Injury
Other Cancer	Other Claim

What Are You Receiving a Claim For?

Agent Orange Related Claims Received
Neuropathy	Amyloidosis
Chloracne	Chronic B-Cell/CCL Leukemias
Diabetes Mellitus (Type 2)	Hodgkin's Disease
Ischemic Heart Disease	Multiple Myeloma
Non-Hodgkin's Lymphoma	Parkinson's Disease
Porphyria Cutanea Tarda	Prostate Cancer
Respiratory Cancers	Soft Tissue Sarcoma

Non-Agent Orange Related Claims Received
PTSD	Gunshot/Shrapnel Wound
Loss of Appendage	Hearing Loss/Tinnitus
Eyesight Loss	Back Injury
Other Cancer	Other Claim

What Percent is Your Disability?

Did You Have Help Filling Your Claim?

Yes
No

If Yes, Who Did You Receive Help From?

Who Helped You With the Claim?
American Legion	VFW	AMVETS
DAV	VA Office	Vietnam Vets of A.
County VSO	State VA Office	Fellow Vet
Wounded Warriors	Private Attorney	Other:

What State Did You File Your Claim In?

Are You A Purple Heart Recipient?

Yes
No

May We Share Your Information With Other Members via Phone, E-mail, or our Website?

NOTE: We Will NOT Include Your Name in Anything Posted to the 589th Website.

Yes, Name and Info
Yes, Info Only
No
Please Enter Your First and Last Name:

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