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SCORE-Bench

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DIABETES AGENT ORANGE SERVICE IN VIETNAM DEC 1972
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17. LIST VA MEDICAL CENTER(S) (VAMC) AND DEPARTMENT OF DEFENSE (DOD) MILITARY TREATMENT FACILITIES (MTF) WHERE YOU RECEIVED TREATMENT AFTER DISCHARGE FOR YOUR CLAIMED DISABILITY(IES) LISTED IN ITEM 16 AND PROVIDE APPROXIMATE BEGINNING DATE (Month and Year) OF TREATMENT. IF ADDITIONAL SPACE IS NEEDED ATTACH A SEPARATE SHEET AND INCLUDE YOUR NAME, SOCIAL SECURITY NUMBER AND ITEM NUMBER.
NOTE: If treatment began from 2005 to present, you do not need to provide dates in Item 17B.
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A. ENTER THE DISABILITY TREATED AND NAME/LOCATION OF THE TREATMENT FACILITY B. DATE OF TREATMENT (MM-YYYY) C. CHECK THE BOX IF YOU DO NOT HAVE DATE(S) OF TREATMENT
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HEARING LOSS 12
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1973
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DIABETES
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NOTE: IF YOU WISH TO CLAIM ANY OF THE FOLLOWING, COMPLETE AND ATTACH THE REQUIRED FORM(S) AS STATED BELOW. (VA forms are available at www.va.gov/vaformss)
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For: Required Form(s):
Supplemental Claims VA Form 20-0995
Dependents VA Form 21-686c and, if claiming a child aged 18-23 years and in school, VA Form 21-674
Individual Unemployability VA Form 21-8940 and 21-4192
Mental Health Condition(s) VA Form 21-0781
Specially Adapted Housing or Special Home Adaptation VA Form 26-4555
Auto Allowance VA Form 21-4502
Veteran/Spouse Aid and Attendance benefits VA Form 21-2680 or, if based on nursing home attendance, VA Form 21-0779
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VA FORM 21-526EZ, NOV 2022
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Page 11
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Financing a big investment push in emerging markets and developing countries for sustainable, resilient and inclusive recovery and growth
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MAY 2022
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LSE
Grantham Research Institute on Climate Change and the Environment
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