Get Va Form 21 0960j 3

Completing the Va Form 21 0960j 3 is an important step for individuals applying for disability benefits related to prostate cancer. This guide will provide clear instructions on how to effectively fill out the form online, ensuring all necessary information is captured accurately.

Follow the steps to fill out the Va Form 21 0960j 3 online successfully.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Enter the name of the patient or veteran in the designated field.
3. Provide the patient or veteran's social security number.
4. In Section I, indicate whether the veteran has been diagnosed with prostate cancer by selecting 'Yes' or 'No'. If 'Yes', complete Item 1B by providing relevant diagnoses, ICD codes, and dates of diagnosis.
5. In Section II, summarize the medical history related to the prostate cancer condition in Item 2A, and indicate the disease status (Active or Remission) in Item 2B.
6. For Section III, indicate if the veteran has completed or is currently undergoing treatment for prostate cancer. If 'Yes', specify the treatment types, including dates.
7. In Section IV, answer whether there is a voiding dysfunction. If 'Yes', complete the subsequent items regarding severity and other factors.
8. For Section V, state if there is a history of recurrent urinary tract or kidney infections, and provide treatment modalities if applicable.
9. Complete Section VI regarding erectile dysfunction, answering all relevant questions.
10. In Section VII, indicate if there is retrograde ejaculation, providing necessary information as required.
11. Describe any residual conditions or complications due to prostate cancer in Section VIII.
12. In Section IX, provide information on any pertinent physical findings or symptoms.
13. For Section X, indicate the presence of any significant diagnostic test findings.
14. Fill out Section XI, detailing how prostate cancer impacts the veteran's ability to work.
15. Add any remarks in Section XII, if necessary.
16. In Section XIII, the physician must certify the information by providing their signature, printed name, phone and fax number, medical license number, and address.
17. Once the form is completed, users can save changes, download, print, or share the form as needed.

Complete your documents online today to ensure timely submission.