Get Va Form 21-0960g-1. Esophageal Abnormalities - Disability Benefits Questionnaire

Filling out the VA Form 21-0960G-1 is an important step for individuals seeking disability benefits related to esophageal conditions. This comprehensive guide will help you navigate and complete the form efficiently and accurately.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to download the form and open it in your preferred editor.
2. Begin by providing the name and social security number of the patient or veteran at the top of the form. Ensure that this information is accurate, as it is critical for the processing of the disability claim.
3. In Section I, diagnose the esophageal condition. Answer whether the veteran currently has or has ever been diagnosed with an esophageal condition by selecting 'Yes' or 'No'. If 'Yes', indicate the specific diagnoses in 1B, along with the ICD code and date of diagnosis for each.
4. In Section II, summarize the medical history regarding the veteran's esophageal conditions. Also, indicate if the treatment plan includes continuous medication and list the specific medications if applicable.
5. Section III requires you to mark any signs or symptoms associated with the conditions. For each symptom checked, state the frequency of occurrence and average duration as specified.
6. In Section IV, specify if the veteran has an esophageal stricture, spasm, or diverticulum, and provide details about the severity of the condition.
7. Section V asks for any other pertinent findings, complications, or symptoms. Provide a brief summary if applicable, and mention any related scars.
8. In Section VI, indicate whether any diagnostic tests have been performed. Check all relevant studies and include dates and results where necessary.
9. Section VII focuses on the functional impact of the esophageal conditions on the veteran's ability to work. If applicable, describe how each condition might affect occupational capabilities.
10. Finally, complete Section VIII with any remarks and Section IX by certifying the information provided. The examining physician should sign, print their name, and provide contact information.
11. Once completed, you can save, download, print, or share the form as needed for submission.

Start filling out your VA Form 21-0960G-1 online today to ensure your disability benefits application is processed smoothly.