Crsc Reconsideration Request Form - Crsc Form 12e

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CRSC Reconsideration Request Form
Name: _________________________________________________________________________________________
(Last Name)
(First Name)
(MI)
SSN:_______________________
Previous Claim Number:________________________
Address:________________________________________________________________________________________
Contact Phone: (_____) ________________
Email Address:___________________________________________
(_____) ________________
……………………………………………………………………………………………………………………………………………………………………………………….
Request for Reconsideration for (check all that apply):
____ I have been awarded these additional conditions by the VA, which may qualify me for CRSC:
_______________________________________________________________________________________________
____ I have been awarded Special Monthly Compensation (SMC) by the VA.
____ I have obtained new medical evidence which may verify the combat-related link to the following previously
requested disability. (Please state VA code or affected area): ____________________________________________
_______________________________________________________________________________________________
____ I am providing the requested information for reconsideration (For example: DD Fm 214, full VA rating decision, VA
code sheet, MEB narrative, LOD or DA Form 199 Physical Evaluation Board Proceedings)
____ OTHER: (Reason is not listed above)_____________________________________________________________
_______________________________________________________________________________________________
Signature: __________________________________________ DATE: __________________________
Please note: Submit only the new and substantive documentation that supports this request. All previously submitted
documents will be included when reviewing your claim for reconsideration.
Please note: We do not address Individual Employability (IU), changes to dependents or pay inquiries. For questions
regarding these issues, please contact DFAS at 1-888-332-7411.
…………………………………………………………………………………………………………………………………………………………………………………………...
For more information on CRSC, please visit our
Mail, Fax or Email your signed request to:
website at
DEPARTMENT OF THE ARMY
U.S. ARMY HUMAN RESOURCES COMMAND
If you have any questions, do not hesitate to
ATTN: AHRC-PDR-C (CRSC) DEPT. 420
contact our Call Center. The toll free number
FT. KNOX, KY 40122-5402
is: 1-866-281-3254 Option 4 or call
1-888-ARMYHRC (276-9472)
eFAX: 1-502-613-9550
Email:
usarmy.knox.hrc.mbx.tagd-crsc-claims@mail.mil
CRSC Form 12e
August 2014

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