Form Login Account (optional)
New Users / Returning Users CLICK HERE to setup or return to your account for this form.  Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish the form. The account you establish is only for this form.   Email addresses will be confidential.  Contact admin@gulfwarcouncil.com if you have any problems or questions.
 
01Business_glasses_r_000000_FFFFFF.jpg

GULF WAR ILLNESSES AND EXPOSURES TO INCLUDE CIVILIANS AND OTHER VETERAN ERA EXPOSURES - QUALITY OF HEALTHCARE AND BENEFITS (page 4)

Branch of military or civilian status. If you are both, a veteran and a spouse of a veteran, answer only for yourself as a veteran. Spouses or families of deceased or severely disabled veterans may answer questions they know about in behalf of their deceased or disabled veteran family member.
Era of conflicts or operations you served in.











Your country of origin/citizenship (not the country you were deployed to).
Gender

Type of health insurance you have now.






HELP (or lack thereof) PROVIDED BY DoD, MoD, or VA
Answer the following to the best of your knowledge. There are 12 eras/columns listed, so please scroll down the find the eras/columns that apply to you. (Vietnam, Gulf War, Operation Iraqi Freedom, Operation Enduring Freedom, Bosnia, Afghanistan, Other era/campaign, Civilian, SHAD, Agent Orange, Edgewood Test Veterans, Ionizing Radiation Veterans) You need only to answer the era(s)/column(s) that apply to you.
 VIETNAM GULF WAR OPERATION IRAQI FREEDOM OPERATION ENDURING FREEDOM
 YESNONOT SUREN/AYESNONOT SUREN/AYESNONOT SUREN/AYESNONOT SUREN/A
Have you had to wait long (longer than one month) before being scheduled for treatment at the VA?
Are you able to work?
Is your spouse able (if applicable) to work?
Do you have other family members in your home to support?
Do you have a condition(s) which have been service-connected?
Do you live alone?
Do you have support outside your home to help you?
Do you live a long distance (more than 50 miles) from the VA?
Are you able to drive?
Have you filed for compensation with the VA for any service-connected conditions?
Have you been awarded service-connected ratings?
Did you file for Social Security Disability for the service-connected conditions?
Were you awarded Social Security Disability?
Do you feel you were informed about your veterans rights and benefits adequately?
Do you know who to go to when you have not received satisfactory treatment? (Patient Advocate, Chief of Staff, Senator, etc.)
Do you use the help of a Service Officer (DAV, VFW, American Legion, etc.)?
Has your Service Officer been able to help you satisfactorily?
Have you (or do you plan to) use a private lawyer to help you resolve problems with your veterans affairs office?
Have you (or do you plan to) use a private lawyer to help you resolve problems with Social Security?
Do you feel your primary care provider is familiar with your issues of toxic exposures?


HELP (or lack thereof) PROVIDED BY DoD, MoD, or VA
Answer the following to the best of your knowledge. You need only to answer the era(s)/column(s) that apply to you.
 BOSNIA AFGHANISTAN OTHER ERA/CAMPAIGN CIVILIAN
 YESNONOT SUREN/AYESNONOT SUREN/AYESNONOT SUREN/AYESNONOT SUREN/A
Have you had to wait long (longer than one month) before being scheduled for treatment at the VA?
Are you able to work?
Is your spouse able (if applicable) to work?
Do you have other family members in your home to support?
Do you have a condition(s) which have been service-connected?
Do you live alone?
Do you have support outside your home to help you?
Do you live a long distance (more than 50 miles) from the VA?
Are you able to drive?
Have you filed for compensation with the VA for any service-connected conditions?
Have you been awarded service-connected ratings?
Did you file for Social Security Disability for the service-connected conditions?
Were you awarded Social Security Disability?
Do you feel you were informed about your veterans rights and benefits adequately?
Do you know who to go to when you have not received satisfactory treatment? (Patient Advocate, Chief of Staff, Senator, etc.)
Do you use the help of a Service Officer (DAV, VFW, American Legion, etc.)?
Has your Service Officer been able to help you satisfactorily?
Have you (or do you plan to) use a private lawyer to help you resolve problems with your veterans affairs office?