Get Va Form 21-0960i-5 (3-11) - Veterans Benefits Administration - Us ... - Vba Va

Filling out the VA Form 21-0960I-5 is a crucial step for veterans seeking disability benefits due to nutritional deficiencies. This guide provides a comprehensive and user-friendly approach to assist you in completing the form accurately and effectively.

Follow the steps to fill out the VA Form 21-0960I-5 accurately.

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 name is spelled correctly as it appears on official documents.
3. Next, input the veteran's social security number in the appropriate section. This information is critical for processing the claim.
4. In Section I, diagnose whether the veteran has a nutritional deficiency by selecting 'Yes' or 'No' for Item 1A. If 'Yes,' proceed to complete Item 1B by checking all relevant conditions and providing ICD codes and dates of diagnosis.
5. For additional diagnoses, use the format provided in Item 1C. It's important to be thorough to ensure all necessary conditions are covered.
6. Move on to Section II, where you will describe the medical history related to the nutritional deficiency condition in Item 2A, including onset and course.
7. Indicate whether continuous medications are required for control in Item 2B. If 'Yes,' list the medications used.
8. Proceed to Section III, where you will detail any findings, signs, or symptoms associated with the conditions diagnosed in Section I. Answer the questions and describe symptoms as necessary.
9. In Section IV, note any scars or other pertinent physical findings related to the conditions listed in Section I.
10. If any significant diagnostic test findings exist, record them in Section V.
11. In Section VI, describe how the nutritional deficiency condition impacts the veteran's ability to work, if applicable.
12. Complete Section VII by adding any remarks that need to be addressed.
13. Finally, in Section VIII, ensure the physician's signature and necessary contact details are provided. Review the form for completeness before proceeding.
14. Once finished, save your changes, download the completed form, print it for your records, or share it as needed.

Start completing your documents online today to ensure a smooth process for your benefits application.