D9416 - Disfigurement and Social Impairment Medical Impairment Assessment

Form ID
For providers
Compensation provider

This assessment relates to embarrassment experienced by the veteran, and the impact on social interaction, as a result of conditions which are noticeable or disfiguring.

If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.

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