
None Mild Moderate Severe Left lower extremity: None Mild Moderate Severe 3B. Other symptoms (describe symptoms, location and severity): SECTION IV - MUSCLE STRENGTH TESTING 4A. Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength All normal Elbow flexion: Rig.
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How to fill out the VA Form 21-0960C-10 online
Filling out the VA Form 21-0960C-10 is essential for veterans seeking disability benefits related to peripheral nerve conditions. This guide provides clear, step-by-step instructions to help you successfully complete the form online.
Follow the steps to fill out the VA Form 21-0960C-10 effectively.
- Click ‘Get Form’ button to access the VA Form 21-0960C-10 and open it in your preferred online editor.
- Begin by entering the patient's or veteran's full name and Social Security number at the top of the form. Ensure the information is accurate and matches official documents.
- Proceed to Section I - Diagnosis, and indicate whether the veteran has a peripheral nerve condition. If yes, fill out the relevant diagnoses, including the ICD code and date of diagnosis.
- In Section II - Medical History, provide a brief summary describing the history of the veteran's peripheral nerve condition, including its onset and course.
- Continue to Section III - Symptoms. Indicate whether the veteran has symptoms attributable to any peripheral nerve conditions and specify the location and severity of these symptoms.
- Move to Section IV - Muscle Strength Testing, and rate the strength according to the provided scale for each muscle group as directed.
- In Section V - Reflex Exam, assess the deep tendon reflexes and document your findings.
- For Section VI - Sensory Exam, indicate results for sensation testing for light touch and document any abnormal findings.
- Complete Section VII - Trophic Changes by indicating if the veteran has any related changes.
- Assess gait in Section VIII, noting whether it is normal or abnormal, and provide a description if necessary.
- If applicable, conduct special tests for median nerve evaluation in Section IX and record the results.
- In Sections X and XI, evaluate the severity of affected nerves for both upper and lower extremities, detailing their condition.
- Document the use of any assistive devices in Section XII, indicating their frequency of use.
- Assess functional impairment in Section XIII, noting any extremities affected by the condition.
- In Section XIV, provide details about any pertinent physical findings or other significant conditions.
- If applicable, document any diagnostic testing results in Section XV.
- Indicate whether the peripheral nerve condition impacts the veteran's ability to work in Section XVI.
- In Section XVII, add any remarks or additional information that may be relevant.
- Finally, Section XVIII requires the physician's certification and details. Ensure that all required signatures and information are included.
- Review the form for completeness and accuracy. Once satisfied, you can save changes, download, print, or share the completed form as needed.
Start completing your VA Form 21-0960C-10 online today for a smoother application process.
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Get answers to your most pressing questions about US Legal Forms API.
What is the VA form for total and permanent disability?
Use VA Form 21-526EZ when you want to apply for VA disability compensation (pay) and related benefits.
What is moderately severe incomplete paralysis?
Incomplete (moderate) paralysis – The nerve is not completely paralyzed, and there are symptoms such as tingling, numbness, and moderate pain which significantly affect the body part's ability to fully function.
What is the VA rating criteria for neuropathy?
The VA disability rating for peripheral neuropathy ranges between 10% (mild) to 40% (complete). Your exact rating will depend on the frequency and severity of your symptoms. Remember that the maximum rating of 40% can be assigned to every extremity affected by peripheral neuropathy.
What is evidence of neuropathy?
Signs and symptoms of peripheral neuropathy might include: Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms. Sharp, jabbing, throbbing or burning pain. Extreme sensitivity to touch.
How does the VA test for neuropathy?
Results: The VA Neuropathy Scale (VANS) tests balance, gait, reflexes, foot inspection, vibration, and pinprick. Possible scores range from 0 to 50 (worst). From the ROC curve, a cutoff of >2 points on the VANS sets the sensitivity and specificity of detecting PN at 98 and 91%, respectively.
What is the VA rating for upper extremity neuropathy?
Typically speaking, the maximum VA rating for peripheral neuropathy is 40%, but you may be entitled to more if your symptoms are severe and includes several of your limbs affected.
How do you prove peripheral neuropathy?
a nerve conduction test (NCS), where small metal wires called electrodes are placed on your skin that release tiny electric shocks to stimulate your nerves; the speed and strength of the nerve signal is measured.
How do I prove neuropathy on my VA claim?
In order to get service connection for their neuropathy, veterans must prove to the VA that their condition was caused by their military service or by another service-connected condition. This can be done using medical records and service personnel records.
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