Page 1

15 fields

Fields on page 1

Claim form

Claim for

following

Don’t forget

Page 2

1 field

Page 6

43 fields

Fields on page 6

About You

Previous name (if applicable)

Male

Female

Gender X

Male

Female

Gender X

Residential address

POSTCODE

Work (

)

Home (

)

Mobile

Email address

Yes

Representative’s name

Representative’s address

(

)

(

Date of

Date of discharge

Reason for discharge

Rank

Pay level

Yes

Likely discharge date

Current posting (if still serving)

Last posting (if discharged)

Page 7

27 fields

Fields on page 7

Yes

Contact details of your reserve unit

Yes

Claims reference numbers

Please complete an injury disease

What part of your body is affected? e.g., left arm, neck, lower back

When did the injury happen or DATE

Yes

Name of your supervisor

Date reported

Yes

Page 8

17 fields

Fields on page 8

Other - please specify

What task was being performed when you sustained the injury? e.g., jacking up a Land Rover to change a tyre, cleaning a riﬂe, playing sport.

How did the injury occur? e.g., the jack slipped on loose gravel causing the Land Rover to fall on my leg; the riﬂe discharged and injured my right big toe.

What machinery, equipment, substances or items (if any) were being used at the time of injury? e.g., a Land Rover, a Steyr riﬂe.

Country

State/Territory City/Town

Physical City/Town

Physical location (e.g., barracks, building, oval)

Where were you posted at the time of injury

Page 9

28 fields

Fields on page 9

When was the journey

From

Where were you travelling from

Other - please specify

What time did you leave

What time did you expect to arrive

Where were you travelling to

Other - please specify

What means of transport was used

What were you at the time of the

Yes

From which police station

Page 10

26 fields

Fields on page 10

What aspects of your employment do you think contributed to your disease or illness? (Please attach a separate statement if necessary).

Yes

Government in relation to this

Centrelink beneﬁts

injury, disease or illness

DFRDB or MSBS

111

Veterans’ Entitlements

If it is determined that there is

114

115

may be entitled to a supplement

117

118

Other - please specify what it is you need.

account you want your beneﬁt to

Branch

Address

Account in the name of

Account number

BSB number

Account type (e.g. savings)

Page 11

3 fields

Fields on page 11

Yes

Page 13

14 fields

Fields on page 13

Date

Full name

Address

POSTCODE

Home

Telephone

Work

139

Mobile

Date

Page 14

20 fields

Fields on page 14

Surname

Given name(s)

DVA ﬁle number(s) (if known)

to ﬁll in the Medical Practitioner section on the next page before lodging your claim.

147

aggravated this injury or

If insufﬁcient space, please attach a

Yes

Do not know

signs or symptoms of the

153

154

consultation provided (e.g.

Yes

Page 15

18 fields

Fields on page 15

Surname

Given name(s)

DVA ﬁle number(s) (if known)

must be lodged before payment of medical account can be made.

160

Conﬁrmed

Provisional

Conﬁrmed

of onset of the injury or disease

164

POSTCODE

[

]

Date

Disability Federal · D2020

DRCA Claim for Rehabilitation and Compensation (D2020)

This form is used by current and former Australian Defence Force members to claim compensation and rehabilitation for work-related injuries, diseases or illnesses.

Issued by: Department of Veterans' Affairs (DVA)
Form number: D2020
Jurisdiction: Federal
Length: 15 pages

When do you need this form?

You need this form if you are a current or former member of the Australian Defence Force (including Reserve Forces and Cadets) and have suffered an injury, disease or illness that you believe is related to your military service. This form is specifically for claims under the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988.

What you'll need

Completed injury or disease details form for each condition, signed by a medical practitioner with diagnosis
ADF medical documents including entry medical board questionnaire, clinical notes, specialist reports, and discharge information
Service history (PMKeyS ADO Full Service Record) and most recent payslip
Proof of identity documents as specified in the claim information sheet
Statement describing how your condition relates to your ADF employment

Where to send it

Submit the completed form to the Department of Veterans' Affairs, either through their online portal MyService at https://www.dva.gov.au/myservice/ if you have a PMKeys number, or contact DVA on 1800 VETERAN (1800 838 372) for submission instructions.

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