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TYPE OF APPLIANCE OR NAME OF MEDICATION Artificial leg metal brace wheelchair etc. 7. LOCATION OF VA MEDICAL CENTER WHICH ISSUED THE APPLIANCE OR MEDICATION CERTIFICATION I hereby apply for annual clothing allowance under 38 U.S.C. 1162. I certify that I wear or use a prosthetic or orthopedic appliance described above because of my service-connected disability or that I use a medication for my service-connected...
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va form 21 8678
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