Fillable Printable VA Form 8

VA Form 8

CERTIFICATION OF APPEAL

1. LAST NAME - FIRST NAME - MIDDLE NAME OF VETERAN 2. FILE NO.

3. NAME OF APPELLANT (If other than veteran) 4. INSURANCE FILE NO. OR

LOAN NO. (If pertinent)

DATES OF PROCEDURAL DOCUMENTS

5A. DATE OF NOTIFICATION

OF ACTION APPEALED

5B. DATE OF SOC 5C. DATE OF SUBSTANTIVE

APPLEAL/FORM 9

5D. DATE OF SSOC

(FIRST)

5E. DATE OF SSOC

(SECOND)

5F. DATE OF SSOC

(THIRD)

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

7. IF APPLICABLE, WHAT TYPE OF HEARING WAS REQUESTED?

A. DECLINED OPTIONAL BOARD HEARING

B. REQUESTING HEARING BY VIDEOCONFERENCE

C. REQUESTED HEARING IN WASHINGTON, DC

D. REQUESTED HEARING AT A LOCAL VA OFFICE

(Travel Board)

E. NO HEARING REQUESTED

8. REMARKS (Place additional remarks in Box 13, on following page)

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.

9. NAME AND LOCATION OF CERTIFYING OFFICE 10. ORGANIZATIONAL ELEMENT CERTIFYING APPEAL

11A. SIGNATURE OF CERTIFYING OFFICIAL 11B. TITLE 11C. DATE

12A. SIGNATURE OF MEDICAL MEMBER (Insurance use only) 12B. TITLE 12C. DATE

VA FORM

SEP 2017

SUPERSEDES VA FORM 8, JUNE 2008,

WHICH WILL NOT BE USED.

CERTIFICATION OF APPEAL

13. ADDITIONAL REMARKS

VA FORM 8, SEP 2017 PAGE 2 OF 2