Vietnam -THE WAR PLUS AGENT ORANGE and MORE : AGENT ORANGE! STATEMENT IN SUPPORT OF CLAIM 2 18 15

AGENT ORANGE! STATEMENT IN SUPPORT OF CLAIM 2

OMB Approved No. 29004)659

Respondent Burden: 1 hour 10 minutes

						VA DATE STAMP DO NOT WRITE IN THIS SPACE
STATEMENT IN SUPPORT OF CLAIM FOR SERVICE CONNECTION FOR POST-TRAUMATIC STRESS DISORDER (PTSD)
INSTRUCTIONS: List the stressful incident or incidents that occurred in service that you feel contributed to your current condition. For each incident, provide a description of what happened, the date, the geographic location, your unit assignment and dates of assignment, and the full names and unit assignments of servicepersons you know of who were killed or injured during the incident. Please provide dates within at least a 60-day range and do not use nicknames. It is important that you complete the fom in detail and be as specific as possible so that research of military records can be thoroughly conducted. If more space is needed, attach a separate sheet, indicating the item number to which the answers apply.
l. NAME OF VETERAN (First, Middle, Last) Mark R Rienzie				2. VA FILE NO. 08642-0997
STRESSFUL INCIDENT NO. 1 •
3A. DATE INCIDENT OCCURRED (Mo., day, yr.) OCT PA Þrå	3B. LOCATION OF INCIDENT (City, state, Country, Province, landmark or military installation) A)
3C. UNIT ASSIGNMENT DURING INCIDENT (Such as, DIVISION, WING, BATTALION, CALVARY, SHIP) Co				3D. DATES OF UNIT ASSIGNMENT (Mo., day, yr.)
				FROM			TO C q 70

3F. MEDALS OR CITATIONS YOU RECEIVED BECAUSE OF THE INCIDENT
INFORMATION ABOUT SERVICEPERSONS WHO WERE KILLED OR'INJURED DURING INCIDENT NO. 1 (ATTACHA SEPARATE SHEET IF MORE SPACE IS NEEDED)
4A. NAME OF SERVICEPERSON (First, Middle, Last)			4B. RANK		4C. DATE OF INJURY/DEATH (Mo., day, yr.)
41). PLEASE CHECK ONE [2 KILLED IN ACTION C] WOUNDED IN ACTION C] KILLED NON-BATTLE C] INJURED NON-BATTLE		4E. UNIT ASSIGNMENT DURING INCIDENT (Such as, DIVISION, WING, BATTALION CALVARY, SHIP)
5A. NAME OF SERVICEPERSON (First, Middle, Last)			5B. RANK		5C. DATE OF INJURY/DEATH (Mo., day, yr.)
50. PLEASE CHECK ONE C] KILLED IN ACTION C] WOUNDED IN ACTION KILLED NON-BATfLE C] INJURED NON-BATTLE		5E. UNIT ASSIGNMENT DURING INCIDENT (Such as, DIVISION, WING, BATTALION, CALVARY, SHIP)

VA FORM 21-0781 EXISTING STOCKS OF VA FORM 21-0781, JUL 2004,

OCT 2007

Secrets of Vietnam: The Long Range Recon Patrolhttps://youtu.be/9rLZV6oXb3w 75th Infantry - Must See Video

AGENT ORANGE and HOMELESS VETERANS
http://markrienzievietnamwar.blogspot.com/2015/09/agent-orange-and-homeless-veteranc.html

Resume:
http://markrienzieresume.blogspot.com/2015/08/mark-r.html

AGENT ORANGE EXPOSURE
http://markrienzievietnamwar.blogspot.com/2015/08/exposureto-agent-orange-in-vietnam-for.html