Describe what happened during active duty service that caused or aggravated this condition.

Approximately when did this event or injury occur?

Where were you stationed when this event or injury took place?

Did this event or injury take place during combat?

Did you ever see a medic for this condition while you were in service?

To the best of your recollection, what did the medic say and what treatment did they provide?

Did anyone else witness this event or injury, or did you tell anyone about this event or injury when it happened? Who did you tell and when?

When did you start experiencing symptoms? How your symptoms have worsened over time:

Describe how these symptoms affect your day-to-day life at home and at work:

Is there anything else you would like to add to your statement?