import { chromium } from 'playwright';
const browser = await chromium.launch();
const page = await browser.newPage();
// Navigate to VA.gov
await page.goto('https://www.va.gov/find-forms/'');
// Start new disability claim
await page.click('[data-testid="start-new-claim"]');
await page.selectOption('[name="claim_type"]', 'original_claim');
// Veteran information
await page.fill('[name="last_name"]', 'Martinez');
await page.fill('[name="first_name"]', 'James');
await page.fill('[name="middle_name"]', 'Michael');
await page.fill('[name="suffix"]', '');
await page.fill('[name="ssn"]', '123-45-6789');
await page.fill('[name="va_file_number"]', 'C-12345678');
// Contact information
await page.fill('[name="date_of_birth"]', '08/15/1985');
await page.selectOption('[name="gender"]', 'male');
// Mailing address
await page.fill('[name="address_line_1"]', '789 Veterans Boulevard');
await page.fill('[name="address_line_2"]', 'Apt 4D');
await page.fill('[name="city"]', 'Jacksonville');
await page.selectOption('[name="state"]', 'FL');
await page.fill('[name="zip"]', '32202');
await page.selectOption('[name="country"]', 'USA');
// Phone numbers
await page.fill('[name="phone_home"]', '904-555-0123');
await page.fill('[name="phone_mobile"]', '904-555-0124');
await page.fill('[name="email"]', 'jmartinez@email.com');
// Contact preferences
await page.check('[name="contact_by_email"]');
await page.check('[name="contact_by_phone"]');
// Service information
await page.selectOption('[name="branch_of_service"]', 'army');
await page.fill('[name="service_number"]', 'US-123456789');
// Service period 1
await page.fill('[name="service_start_date_1"]', '06/15/2003');
await page.fill('[name="service_end_date_1"]', '08/20/2011');
await page.selectOption('[name="separation_type_1"]', 'honorable');
// Service period 2 (if applicable)
await page.click('[data-testid="add-service-period"]');
await page.fill('[name="service_start_date_2"]', '09/01/2011');
await page.fill('[name="service_end_date_2"]', '05/30/2015');
await page.selectOption('[name="separation_type_2"]', 'honorable');
// Reserve/National Guard service
await page.check('[name="reserve_service"]');
await page.fill('[name="reserve_component"]', 'Army National Guard');
await page.fill('[name="unit_name"]', '53rd Infantry Brigade Combat Team');
await page.fill('[name="unit_phone"]', '904-555-0200');
// Combat service
await page.check('[name="served_in_combat"]');
await page.fill('[name="combat_locations"]', 'Iraq (2007-2008), Afghanistan (2010-2011)');
// Prisoner of war
await page.selectOption('[name="pow_status"]', 'no');
// Medals and awards
await page.fill('[name="awards"]', 'Bronze Star, Purple Heart, Combat Infantryman Badge, Army Commendation Medal');
// Disabilities being claimed
// Condition 1: PTSD
await page.click('[data-testid="add-disability"]');
await page.fill('[name="condition_name_1"]', 'Post-Traumatic Stress Disorder (PTSD)');
await page.selectOption('[name="condition_cause_1"]', 'combat');
await page.fill('[name="condition_start_date_1"]', '09/2008');
await page.fill('[name="condition_description_1"]', 'Recurring nightmares, flashbacks to combat situations, anxiety, hypervigilance, difficulty sleeping. Symptoms began during deployment to Iraq and have persisted.');
// Condition 2: Tinnitus
await page.click('[data-testid="add-disability"]');
await page.fill('[name="condition_name_2"]', 'Tinnitus');
await page.selectOption('[name="condition_cause_2"]', 'noise_exposure');
await page.fill('[name="condition_start_date_2"]', '06/2007');
await page.fill('[name="condition_description_2"]', 'Constant ringing in both ears. Began after prolonged exposure to weapons fire and explosions during combat operations.');
// Condition 3: Lower back injury
await page.click('[data-testid="add-disability"]');
await page.fill('[name="condition_name_3"]', 'Chronic Lower Back Pain');
await page.selectOption('[name="condition_cause_3"]', 'injury');
await page.fill('[name="condition_start_date_3"]', '03/2010');
await page.fill('[name="condition_description_3"]', 'Lumbar spine injury from IED blast. Chronic pain, limited range of motion, difficulty standing for extended periods.');
// Condition 4: Knee injury
await page.click('[data-testid="add-disability"]');
await page.fill('[name="condition_name_4"]', 'Right Knee Injury');
await page.selectOption('[name="condition_cause_4"]', 'injury');
await page.fill('[name="condition_start_date_4"]', '03/2010');
await page.fill('[name="condition_description_4"]', 'Right knee damaged in same IED incident. Torn meniscus, chronic pain, instability, arthritis.');
// Treatment history
await page.check('[name="receiving_va_care"]');
await page.fill('[name="va_facility_1"]', 'Malcom Randall VA Medical Center');
await page.fill('[name="va_facility_city_1"]', 'Gainesville');
await page.selectOption('[name="va_facility_state_1"]', 'FL');
await page.fill('[name="va_treatment_dates_1"]', '2015 - Present');
// Private medical treatment
await page.check('[name="private_treatment"]');
await page.fill('[name="private_provider_1"]', 'Dr. Sarah Orthopedic Surgeon');
await page.fill('[name="private_facility_1"]', 'Jacksonville Orthopedic Center');
await page.fill('[name="private_address_1"]', '456 Medical Plaza');
await page.fill('[name="private_city_1"]', 'Jacksonville');
await page.selectOption('[name="private_state_1"]', 'FL');
await page.fill('[name="private_zip_1"]', '32207');
await page.fill('[name="private_treatment_dates_1"]', '2012-2015');
// Mental health treatment
await page.fill('[name="mental_health_provider"]', 'Dr. Michael Psychiatrist');
await page.fill('[name="mental_health_facility"]', 'Veterans Mental Health Clinic');
await page.fill('[name="mental_health_dates"]', '2015 - Present');
// Hospitalizations
await page.check('[name="hospitalizations"]');
await page.fill('[name="hospital_name_1"]', 'Walter Reed Army Medical Center');
await page.fill('[name="hospital_admission_date_1"]', '04/01/2010');
await page.fill('[name="hospital_discharge_date_1"]', '04/15/2010');
await page.fill('[name="hospital_reason_1"]', 'Treatment for injuries sustained in IED explosion');
// Supporting documents
await page.click('[data-testid="upload-dd214"]');
await page.setInputFiles('[name="discharge_papers"]', './documents/dd214.pdf');
await page.click('[data-testid="upload-service-medical"]');
await page.setInputFiles('[name="service_medical_records"]', './documents/service_treatment_records.pdf');
await page.click('[data-testid="upload-private-medical"]');
await page.setInputFiles('[name="private_medical_records"]', './documents/private_treatment_records.pdf');
await page.click('[data-testid="upload-buddy-statements"]');
await page.setInputFiles('[name="buddy_statements"]', './documents/witness_statements.pdf');
// Special circumstances
await page.check('[name="combat_related"]');
await page.check('[name="caused_by_service"]');
// Homelessness
await page.selectOption('[name="homeless_status"]', 'at_risk');
await page.fill('[name="homeless_contact"]', 'Florida Veterans Affairs Office');
await page.fill('[name="homeless_phone"]', '904-555-0300');
// Terminal illness
await page.selectOption('[name="terminal_illness"]', 'no');
// Fully developed claim
await page.check('[name="fdc_election"]');
await page.check('[name="understand_fdc"]');
// Direct deposit information
await page.check('[name="direct_deposit"]');
await page.selectOption('[name="account_type"]', 'checking');
await page.fill('[name="routing_number"]', '063100277');
await page.fill('[name="account_number"]', '123456789012');
await page.fill('[name="bank_name"]', 'Navy Federal Credit Union');
// Payment address (if different)
await page.selectOption('[name="payment_address_same"]', 'yes');
// Dependents
await page.check('[name="has_dependents"]');
// Spouse information
await page.fill('[name="spouse_first_name"]', 'Jennifer');
await page.fill('[name="spouse_middle_name"]', 'Ann');
await page.fill('[name="spouse_last_name"]', 'Martinez');
await page.fill('[name="spouse_ssn"]', '987-65-4321');
await page.fill('[name="spouse_dob"]', '11/20/1987');
await page.fill('[name="marriage_date"]', '06/15/2012');
await page.selectOption('[name="marriage_type"]', 'ceremonial');
// Children
await page.click('[data-testid="add-child"]');
await page.fill('[name="child_first_name_1"]', 'Emily');
await page.fill('[name="child_middle_name_1"]', 'Rose');
await page.fill('[name="child_last_name_1"]', 'Martinez');
await page.fill('[name="child_ssn_1"]', '234-56-7890');
await page.fill('[name="child_dob_1"]', '08/10/2013');
await page.selectOption('[name="child_relationship_1"]', 'biological');
await page.check('[name="child_unmarried_1"]');
await page.check('[name="child_under_18_1"]');
// Employment information
await page.selectOption('[name="employment_status"]', 'unemployed');
await page.fill('[name="last_employment_date"]', '03/2015');
await page.fill('[name="unable_to_work_date"]', '03/2015');
await page.fill('[name="unemployment_reason"]', 'Service-connected disabilities prevent full-time employment');
// Education and training
await page.check('[name="using_gi_bill"]');
await page.fill('[name="school_name"]', 'Florida State College at Jacksonville');
await page.fill('[name="education_start_date"]', '08/2016');
// Other benefits
await page.check('[name="receiving_ssdi"]');
await page.fill('[name="ssdi_start_date"]', '01/2016');
await page.fill('[name="ssdi_monthly_amount"]', '1500');
// Military retirement
await page.selectOption('[name="receiving_military_retirement"]', 'no');
// VA pension
await page.selectOption('[name="receiving_va_pension"]', 'no');
// Intent to file date
await page.fill('[name="intent_to_file_date"]', '01/15/2025');
// Certification and signatures
await page.check('[name="certify_accuracy"]');
await page.check('[name="certify_authorization"]');
await page.check('[name="understand_penalties"]');
await page.check('[name="authorize_disclosure"]');
await page.check('[name="agree_to_exam"]');
// Privacy act notice acknowledgment
await page.check('[name="privacy_act_acknowledged"]');
// Veteran signature
await page.fill('[name="veteran_signature"]', 'James Michael Martinez');
await page.fill('[name="signature_date"]', '03/10/2025');
// Representative information (if applicable)
await page.selectOption('[name="has_representative"]', 'yes');
await page.fill('[name="representative_name"]', 'Veterans Service Organization - DAV');
await page.fill('[name="representative_phone"]', '904-555-0400');
await page.fill('[name="representative_email"]', 'davjacksonville@dav.org');
await page.click('[data-testid="submit-claim"]');
// Download confirmation
await page.click('[data-testid="download-confirmation"]');
await browser.close();
