Va Form 21-0958 - Notice Of Disagreement

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INFORMATION AND INSTRUCTIONS FOR COMPLETING NOTICE OF DISAGREEMENT (NOD)
IMPORTANT: PLEASE READ THE INFORMATION BELOW CAREFULLY TO HELP YOU COMPLETE THIS FORM QUICKLY AND
ACCURATELY. SOME PARTS OF THE FORM ALSO CONTAIN NOTES OR SPECIFIC INSTRUCTIONS FOR COMPLETING THAT PART.
THE USE OF THIS FORM IS MANDATORY TO INITIATE AN APPEAL FROM A DECISION ON COMPENSATION CLAIMS. THIS FORM HAS
SEVERAL KEY COMPONENTS, WHICH WHEN FILLED OUT COMPLETELY AND ACCURATELY, WILL DECREASE THE AMOUNT OF TIME
IT TAKES TO PROCESS YOUR NOD.
FREQUENTLY ASKED QUESTIONS
For what do I use this standard NOD?
You must use this form if you wish to indicate to your Regional Office (RO) that you disagree with a decision you received regarding your
claim for disability compensation. Examples of these decisions may include entitlement to service connection, percentage of evaluation
assigned, and effective date among other things. This form is the only way that you can initiate an appeal from a decision on your claim for
disability compensation.
Should I fill out this form?
You must fill out this form if you disagree with a decision issued by your RO about your disability compensation claim. This includes an
initial decision, a decision for an increased rating, or any other decision with which you disagree. Only those issues that you list on this
NOD will be considered on appeal. For those issues you do not list on this NOD, you will still have one year from the date of the decision
notification letter to file an appeal for those issues.
Where can I get help?
You can ask the Department of Veterans Affairs (VA) to help you fill out the form by contacting us at 1-800-827-1000. Before you contact
us, please make sure you gather the necessary information and materials, and complete as much of the form as you can.
What should I do when I have finished my NOD?
You should provide your signature in the block provided at the bottom of the second page. Be sure to sign every form you fill out before
you send it to us. If you don't sign the form, VA will return it for you to sign, and it will take longer to process.
Attach any materials that support and explain your NOD.
Mail or take your NOD to the RO that issued the decision or notification that you disagree with, which is the Agency of Original Jurisdiction
(AOJ.)
Do I need to keep a copy of this NOD form?
It is important that you keep a copy of all completed forms and materials you give to VA.
What constitutes a complete NOD form?
Generally, VA will consider your NOD "complete" if the following information is provided on the form:
(1) Part I - Information to identify the claimant such as name, Social Security Number, or VA claim number.
Please note that it would assist VA if you provide all the personal information in Part I. However, if you provide certain information specific
to the claimant such as the claimant's last name and Social Security Number or VA file number, VA will be able to identify the claimant in
our system and would not necessarily consider this NOD incomplete if other information in Part I such as the claimant's address and
telephone number is excluded.
(2) Part III - Information to identify the specific nature of the disagreement.
Please enumerate the issues or conditions for which you seek appellate review in Item 10 of Part III. At a minimum, please indicate the
specific issue of disagreement in Item 10A such as "right knee disability" or "PTSD" and indicate the area of disagreement in Item 10B by
checking the appropriate box. If you disagree with an evaluation of a disability, you may tell us what percentage evaluation you seek in
Item 10C. However, you are not required to indicate the percentage of evaluation sought in Item 10C in order to complete this form.
(3) Part IV - Claimant's signature.
Please be sure to sign the NOD, certifying that the statements on the form are true and correct to the best of the claimant's knowledge and
belief.
IMPORTANT: If you do not provide the above information on this NOD, VA will consider your form incomplete and will request clarification
from you: either 60 days from the date of VA's request for verification or one year from the date of mailing of the notice of decision of the
AOJ, whichever is later. If you do not provide VA with a completed form within that time frame, the decision will become final, and you will
have to file a new claim.
VA FORM
21-0958
JAN 2015

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