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Berta
http://www.justice.gov/usao/nh/hr/Forms/sf95.pdf
You will have at least one entry of damages in 12a,b, or c and make sure you TOTAL the damages in # 12 D.
As Basis for the claim:
You need to state that the VA did not adhere to principles as found within the standard medical community and thus caused you additional disability by their negligence.
You can refer them to specific medical evidence that would support this point and attach copies of it.
If you prepare this evidence with a cover letter and are specific as to documented negligence or malpractice, you might get a phone call from the VA counsel right away and then get a Peer Review done within months.
An FTCA award depends on documented negligence and/or malpractice (they are really the same thing)
and documented evidence of additional disability or death resulting directly from the VA malpractice.
Since FTCA is a legal issue and it involves medical evidence , best to get an IMO that supports malpractice and if it does, a lawyer would be crazy not to represent you.
And best to have a lawyer prepare the SF 95.
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