Service Connected % |  |  | -- |  |  |  | Enrollment Application Date |  |  | --
Effective Date of Combined Evaluation |  |  | -- |  |  |  | Eligibility Verification Method |  |  | --
Eligibility Status |  |  | -- |  |  |  | Veteran Indicator |  |  | --
Eligibility Status Date |  |  | -- |  |  |  | Prisoner of War Indicator |  |  | --

Rated Disabilities |  |  | --

Other Eligibility Factors
Indicator | Type

Rated SC Disabilities