Veterans Disability, Prequalification Questions Privacy Policy | SMS Terms & Conditions (both open in new windows/tabs) Please select your state (Required)AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Are you submitting this form for someone else? (Required) YesNo, this is for myself Name of injured person: Are you a Veteran? (Required) YesNo If Yes, please continue. If No, you can quit. Have you received a decision from the Veterans Administration (VA) (recently or at any time in the past) regarding disability benefits? (Required) YesNo If Yes, please continue. If No, you can quit. Are you interested in securing service connection, or increasing your service-connected VA disability benefits? YesNo If Yes, please continue. If No, you can quit. Are you currently represented by an attorney before the VA? (Required)YesNo If No, please continue. If Yes, please provide their contact information: Name of Attorney: Attorney's Phone#: Attorney's Email: Please leave this field empty. Best way to reach you? (Required)PhoneEmail By checking this box, you agree to receive SMS messages or communications related to Your Case from The Nations Law Firm and/or Chisolm Chisolm & Kilpatrick, and you can reply OPT-OUT at any time. Message and data rates may apply. Message frequency may vary. For assistance after opting in, reply HELP or for more information visit our Privacy Policy and SMS Terms & Conditions - both open in new tabs. REQUIRED - To be sure you are human.4 + 5