Do you have a present service-connected disability or receive service-connected compensation, disability retirement benefits or a pension from the military or the Department of Veterans' Affairs?

• yes
• no

Notes:

"Service-connected disability" includes the award of a Purple Heart.

If you have applied for disability determination to the Department of Veterans' Affairs,
and are likely to receive certification, answer "yes".

If you have not applied or do not have a pending determination of disability, answer "no".