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Separation Health Assessment — Part A

Complete the service-member identification and self-assessment part of the Separation Health Assessment. BDD instructions explain when to submit it.

Use the current official form

Revision: June 2, 2026 · v26_3.

Submit through the applicable official claim channel or BDD intake instructions. There is no universal separate self-assessment mailing address.

Submission instructions

Through the applicable claim channel

BDD supporting self-assessment

Submit with the BDD claim or through the official intake instructions.

Official references

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FACILITY REFERENCE