Good Cause Statement - Missed Comp & Pen

Good Cause Statement - Missed Comp & Pen

Fill out this questionnaire if you missed your Comp & Pen Exam appointment to explain why you couldn’t attend. This helps the VA understand that the missed appointment wasn’t your fault and may allow them to reschedule the exam instead of denying your claim outright.
Name

First NameMiddle NameLast Name
Email
example@example.com
Who are you working with at OSDRI?

Comp & Pen Details
Which claim or condition was your Comp & Pen Exam for?
Examples: back claim, mental health claim, etc. *If you missed more than one, please list ALL claims.
‼️If you do not know which claim or condition your Comp & Pen appointment was for, please contact us before completing this form to find out.

Cilck here to contact us about your missed Comp & Pen appointment.
Were you notified of your Comp & Pen Appointment?
Did you try to reschedule your Comp & Pen Appointment?
Why didn't you call to reschedule your appointment?
You must show "good cause" for missing your appointment. You should have documentation to support the failure to report to the appointment, if necessary.

Examples of good cause may include:
- illness or hospitalization
- death of an immediate family member
- you were not notified of your appointment
- you could not travel for your appointment
If you have documents to support your statement, please upload here.

Cancelof
In as much detail as possible, explain why you missed the Comp & Pen Exam.
If given the opportunity, would you attend a newly scheduled Comp & Pen Exam?

Is there anything else you wish to add to your statement?
My answers are true and accurate to the best of my knowledge and belief.

YesNo
We will review your responses and reformat your statement onto a VA Form 21-4138 (Statement in Support of Claim) for you to esign so we can submit your statement as evidence for your case.

If you have any questions or are having trouble completing this form, please contact us directly for help.
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Comp & Pen Details