Free VA Form VA8 - Certification of Appeal - Federal

CERTIFICATION OF APPEAL
1A. NAME OF APPELLANT (If other than veteran) 1B. RELATIONSHIP TO VETERAN 2. FILE NO. 3. LAST NAME - FIRST NAME - MIDDLE NAME OF VETERAN 4. INSURANCE FILE NO. OR LOAN NO. (If pertinent)

THE APPEAL IS FOR (State the question(s) at issue clearly and concisely.)
5A. SERVICE CONNECTION FOR 5B. DATE OF NOTIFICATION OF ACTION APPEALED

6A. INCREASED RATING FOR

6B. DATE OF NOTIFICATION OF ACTION APPEALED

7A. OTHER

7B. DATE OF NOTIFICATION OF ACTION APPEALED

8A. APPELLANT REPRESENTED IN THIS APPEAL BY (Name of organization, attorney or agent)

8B. ONE OF THE FOLLOWING IS ON FILE AS AUTHORITY FOR RECOGNIZING SUCH REPRESENTATIVE IN THIS APPEAL POWER OF ATTORNEY (VA Form 21-22 or VA Form 21-22a) CERTIFICATION THAT VALID POWER OF ATTORNEY IS IN ANOTHER VA FILE (If so, specify file) 9A. IF REPRESENTATIVE IS SERVICE ORGANIZATION, IS VA FORM 646, OR EQUIVALENT, OF RECORD? YES NO 10B. IF HELD, IS TRANSCRIPT IN FILE? YES NO 9B. IF VA FORM 646 IS NOT OF RECORD, EXPLAIN

8C. IF AGENT DESIGNATED, IS HE/SHE ON ACCREDITED LIST? YES NO

10A. WAS HEARING REQUESTED? YES NO 10C. IF REQUESTED BUT NOT HELD, EXPLAIN

11A. ARE CONTESTED CLAIMS PROCEDURES APPLICABLE IN THIS CASE? NO (If "YES," complete item 11B). YES 12A. DATE STATEMENT OF THE CASE FURNISHED

11B. HAVE THE REQUIREMENTS OF 38 U.S.C. 7105a BEEN FOLLOWED? YES NO 12B. SUPPLEMENTAL STATEMENT OF THE CASE REQUIRED AND FURNISHED NOT REQUIRED X-RAYS SLIDES TISSUE BLOCKS

13. RECORDS TO BE FORWARDED TO BOARD OF VETERANS' APPEALS CF OR XCF R&E F LOAN GUAR. F INACTIVE CF OTHER (Specify) 14. REMARKS (Continue on reverse) TRAINING SUB-F DEP. ED. F (Ch. 35) INSURANCE F DENTAL F

OUTPATIENT F HOSPITAL COR. CLINICAL REC.

CERTIFICATION: It is hereby certified that all material evidence is of record, that all contentions advanced by and on behalf of the appellant have been considered under all pertinent laws, and the issues determined.
15. NAME AND LOCATION OF CERTIFYING OFFICE 16. ORGANIZATIONAL ELEMENT CERTIFYING APPEAL

17A. SIGNATURE OF CERTIFYING OFFICIAL

17B. TITLE

17C. DATE

18A. SIGNATURE OF MEDICAL MEMBER (Insurance use only)

18B. TITLE

18C. DATE

VA FORM JUN 2008

8

SUPERSEDES VA FORM 8, OCT 1992, WHICH WILL NOT BE USED.

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CERTIFICATION OF APPEAL
14. REMARKS (Continue from front page)

VA FORM 8, JUN 2008

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