Get Va Form 21 0960a 4

This guide provides step-by-step instructions for completing the Va Form 21 0960a 4 online. The form is essential for veterans applying for disability benefits related to hypertension. By following these instructions, users can ensure a smooth and accurate submission process.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the patient or veteran in the designated field. Ensure the spelling is accurate to avoid any processing delays.
3. Input the patient or veteran's social security number in the corresponding section. This information is necessary for proper identification.
4. Proceed to Section I: Diagnosis. Answer the question regarding the current diagnosis of hypertension or isolated systolic hypertension by selecting 'Yes' or 'No'. If 'Yes', provide the necessary details including the ICD code and date of diagnosis.
5. In the same section, if there are additional diagnoses, list them using the format provided. Ensure to detail any complications if applicable.
6. Move on to Section II: Medical History. Describe the veteran's hypertension history, including its onset and course in the provided text box.
7. Indicate whether the treatment plan includes continuous medication for hypertension by selecting 'Yes' or 'No'. If 'Yes', list the relevant medications.
8. Confirm the initial diagnosis of hypertension by indicating whether it was established through proper blood pressure readings taken on multiple days.
9. Document current blood pressure readings in Section II, as required by the form. Provide as many readings as are applicable.
10. Proceed to Section III: Other Pertinent Physical Findings. Answer the questions regarding related conditions and scars, providing brief descriptions where necessary.
11. In Section IV, describe how the veteran's hypertension affects their ability to work, providing specific examples if applicable.
12. Complete Section V: Remarks, if there are any additional comments or information to be included.
13. Finally, ensure that Section VI is filled out by a physician, with the necessary certification and signature. This section requires contact details and the physician's license number.
14. Once all sections are completed, review the form for accuracy. Save your changes or proceed to download, print, or share the form as needed.

Complete your Va Form 21 0960a 4 online to facilitate your application for benefits today.