Did you serve in any of the following locations?(Required) *select all that apply Afghanistan American Samoa Bahrain Cambodia Camp Lejeune, North Carolina Djibouti Egypt Guam Iraq Johnston Atoll Jordan Korea near DMZ Kuwait Laos Lebanon Oman Qatar Saudia Arabia Somalia Syria Thailand United Arab Emirates Uzbekistan Vietnam Yemen I did not serve in any of the above locations BackNextThis field is required.BackNextDid you serve between 08/02/1990 - Present?(Required) Yes No BackNextThis field is required.Did you serve between 09/11/2001 - Present?(Required) Yes No BackNextThis field is required.Did you serve between 08/05/1953 - 12/31/1987?(Required) Yes No BackNextThis field is required.Did you serve between 01/09/1962 - 06/30/1976?(Required) Yes No BackNextThis field is required.Did you serve between 12/1/1965 - 09/30/1969?(Required) Yes No BackNextThis field is required.Did you serve between 04/16/1969 - 04/30/1969?(Required) Yes No BackNextThis field is required.Did you serve between 01/09/1962 - 07/31/1980?(Required) Yes No BackNextThis field is required.Did you serve between 01/01/1972 - 09/30/1977?(Required) Yes No BackNextThis field is required.Did you serve between 09/01/1967 - 08/31/1971?(Required) Yes No BackNextThis field is required.Do you have a confirmed or suspected medical diagnosis of any of the following? Select all that apply.(Required) Cancer Respiratory condition (ex. asthma, COPD, emphysema, bronchitis) Sinus Condition (ex. sinusitis, rhinitis) Chronic Fatigue Syndrome Chronic Pain / Fibromyalgia Digestive Issues (ex. IBS, constipation, diarrhea) No BackNextThis field is required.Do you have a confirmed or suspected medical diagnosis of any of the following? Select all that apply.(Required) Blood cancer Skin disease High blood pressure Heart disease (ex. coronary artery disease) Hodginks or Non-Hodgkins Lymphoma Parkinson's disease Prostate Cancer Respiratory Cancers (ex. lung, larynx, trachea) Soft-tissue Cancer (ex. muscle, tendons, lymph nodes) Adult-Onset Diabetes No BackNextThis field is required.Do you have a confirmed or suspected medical diagnosis of any of the following? Select all that apply.(Required) Leukemia / Blood Cancer Bladder Cancer Kidney Cancer Liver Cancer Myeloma Non-Hodgkin's lymphoma Parkinson's disease No BackNextThis field is required.Are you currently on active duty?(Required) Yes No BackNextThis field is required.Based on the information you entered, you may qualify for compensation for a presumptive disability. Do you want to be referred to a VFW Accredited Service Officer to assist you with a VA disability claim? *VFW claims assistance is always 100% free!(Required) Yes No BackNextThis field is required.Name(Required) First Last BackNextThis field is required.Email(Required) BackNextThis field is required.State(Required)SelectALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYOtherBackNextThis is a required field.State Other Choice(Required) BackNextThis field is required.Are you located in the Kansas City Metro Area?(Required) YES NO BackNextThis field is required.Are you located in the Washington, D.C. Metro Area?(Required) YES NO BackNextThis field is required.PhoneBy submitting this form, you confirm that you have read and agree with the VFW Privacy Policy and Terms of Service.BackNextPhoneThis field is for validation purposes and should be left unchanged.BackNext Submit
