U.S. DOD Form dod-va-4030b
DECISION RECORD SUPPLEMENT
DATE
CLAIM NO.
C-
BOARD OF VETERANS APPEALS
TO
When the names of Board Members are listed in the spaces above, they are to
participate in a reconsideration decision in this case. Votes will be recorded and
brief reasons stated in the spaces provided. Each participating member will sign
VOTE
and send to the next member listed. The last member will refer the case to the
Chief member of the original section to have the decision prepared. This form
may also be used for any remarks by Board Members.
SIGNATURE OF MEMBER
DATE
SIGNATURE OF MEMBER
DATE
SIGNATURE OF MEMBER
DATE
REASONS
VOTE
REASONS
VOTE
REASONS
VA FORM
SEP 1992(R)
4030b
VOTE
SIGNATURE OF MEMBER
DATE
SIGNATURE OF MEMBER
DATE
SIGNATURE OF MEMBER
DATE
REASONS
VOTE
REASONS
VOTE
REASONS