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
SSN
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Who are you working with at OSDRI?

Missed Appointment 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 your Comp & Pen Appointment was related to, please contact us before completing this form so we can look it up for you.

Click here to contact us
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
In as much detail as possible, explain why you missed your Comp & Pen Appointment.
If given the opportunity, would you attend a newly scheduled Comp & Pen Exam?

Missed Appointment Details