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    VA Form 21-0172
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    VA Form 21-0172 is a form that can be used instead of a physician's statement if the Department of Veterans Affairs (VA) certifies that you are permanently and totally disabled. VA Form 21-0172 must be signed by a person authorized by the VA to do so, and can be obtained from your local VA regional office. The form is used to affirm that you have been medically determined to have a permanent physical, mental, or sensory impairment that severely limits one or more major life activities.
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