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22-1995 Form: What You Should Know

IF YOU ARE BEING REQUIRED BY THIS FORM I am currently being medically separated from the military service of my country because of a disability. I am also currently receiving a VA disability compensation benefits. I have not declared my dependents, and they are not receiving any of their dependent benefits. Furthermore, I am requesting a total separation and the removal from the VA system until such time the disability claims are resolved. When I ask “did service in the military cause you to be disabled?” I mean “did service in the military cause you to be disabled?” What do I need to provide for the evaluation? I need your full name, address, and telephone number. I need to know how much time you have spent in the military. What are the dates? We need to see documents such as DD-214, DD 135, etc. What kind? I am only going to review a few (less than 10) documents to ensure that they have not become obsolete or in disrepair. Do you have something in your possession that could prove that you were physically disabled as a result of the service? We will need your medical records. If your disability claim does not include medical records I will need to get them. If that is not possible, you can get them from civilian physicians. Do you have any of your documents in a public filing location? If you don't have them in your possession right now, then you will need to arrange to have them delivered to us. If they are not in your custody, you will need to get them to us as quickly as possible as well. Has everything been filled out? It will be my responsibility to have my disability information filled out as fast as humanly possible. I will be using my copy of DD 214 and your copy of your DD 135. This form will not be used for “just” a total separation. It will be used for a total separation from the military system. The total separation has been requested. I am currently receiving disability compensation benefits under the Uniformed Services Employment and Reemployment Rights Act (SERRA), and if I get a separation notice I will be receiving some kind of separation pay. We are going to take another look at the information and documents as you give them to us. Let's start our process over. I have been medically separated from the military service of my country because of a disability. I am still receiving benefits under the GI Bill as a dependent of another service member.

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