Marine Mustang Disability Law Firm, LLC

Marine Mustang Disability Law Firm, LLC
199 Barn Door Hills Rd
Granby, CT 06035-2917
910-546-6738
Intake Form

Please read the privacy policy below and then fill out this form in its entirety before our consultation.

Privacy Policy
All information received from a client is strictly confidential. I take every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

Your Social Security Number and other personal information will only be used if you retain me to represent you in your legal matter. I will only use your personal information when your case requires it. Social Security Numbers are most often used to identify parties positively. Government agencies, including the Department of Defense and the Department of Veterans Affairs, require Social Security Numbers to process applications. 

If you have any questions, please do not hesitate to contact me.

If you are seeking assistance with VA disability, please include a copy of all past VA rating decisions, as this will allow me to evaluate your case and assist you properly.

Click here for instructions on accessing past/current VA decision letters.

Follow these steps to access your past and current VA decision letters:
1. Navigate to VA.gov and sign in using any sign-in option.
2. Click on VA Benefits and Health Care at the top of the VA website. You will see a dropdown menu. Select Disability, then Check your claim or appeal status.
3. Find the claim you are looking for. If there has been a decision, it will say Status: Closed. Remember that a decision letter will only be available if your claim is closed.
4. To locate your VA decision letter, click on View Details.
5. On the next page, click Get your claim letters. You will see a list of letters sent by VA in chronological order, with the most recent mailing at the top.
6. Select the letter you need. The decision letter will be downloaded as a PDF file that can be viewed and saved to your computer or mobile device.

A copy of this form will be sent to the primary email upon submission.

Contact information

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Upon submission, a copy of this form will be sent to the primary email.
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List dependent children/parents, to include: (1) biological, adopted, and step-children that are unmarried and below the age of 18, OR (2) unmarried and between 18 and 23 and enrolled in school full-time, OR (3) children permanently disabled before age 18

Please complete this section to the best of your knowledge. If you have been denied service connection for a VA disability claim or believe the VA should have rated you higher for a service-connected disability, please attach those past rating decisions at the bottom of this form.

Please list all currently rated disabilities and the rating percentage/s for each.

If you have past VA rating decisions, please attach them here.

These questions are used to assess your potential eligibility for “total disability based on unemployability,” or TDIU, a special VA rating for those who are unemployed or under-employed due to their service-connected disabilities.

Select all that apply.

After you submit this form, I will review the information and reach out to schedule a free consultation.

This free consultation is to determine if I can assist you with your legal needs, to inform you about the services I can provide, and to discuss the potential agreement for the provision of legal services and the formation of an attorney-client relationship. An initial consultation does not create an attorney-client relationship and does not mean I will act as your legal counsel.

After the initial consultation, if your case or matter is accepted, I will provide you with a retainer agreement to set forth the terms and conditions for my legal services and any applicable fees. An attorney-client relationship only begins once you and I sign the retainer agreement establishing a contractual relationship.

Please note that your legal rights may be affected by laws that place time restrictions on certain discharge upgrade applications or VA disability appeals. If I do not accept your case or matter, or you decide not to retain my services, you should seek alternate legal counsel immediately to ensure your legal rights are not affected.

By checking "Yes" below, I acknowledge that I have read the foregoing notice and understand that Marine Mustang Disability Law Firm, LLC will not act as my recognized legal counsel or take any action on my behalf unless a retainer and fee agreement has been signed and all required fees are paid, where applicable. All information entered on this intake form is accurate to the best of my knowledge. I understand that any inaccuracies or omissions in the requested information may delay or prevent Marine Mustang Disability Law Firm, LLC from providing accurate legal advice and may prompt Marine Mustang Disability Law Firm, LLC to decline or withdraw representation.

Thank you for completing this intake questionnaire. This information will be beneficial in evaluating your case. I will contact you shortly.

Please click the SUBMIT button below when you have finished answering all questions.