F FIBROMYALGIA SYMPTOMS (check all that apply) NO SYMPTOMS EPISODIC WITH EXACERBATIONS PRESENT MORE THAN ONE-THIRD OF THE TIME CONSTANT OR NEARLY CONSTANT OFTEN PRECIPITATED BY ENVIRONMENTAL OR EMOTIONAL STRESS OR OVEREXERTION (If checked, describe): OTHER (describe): C. TENDER POINTS (trigger points) FOR PAIN (check all that apply) None All bilaterally Low cervical region: at anterior aspect of the interspaces between transverse processes of C5-C7 (If checked, indicate side): Right Left Both.
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How to fill out the VA 21-0960C-7 online
The VA 21-0960C-7 form is designated for individuals applying for disability benefits related to fibromyalgia. This guide provides clear, step-by-step instructions to help you navigate the online submission process efficiently and effectively.
Follow the steps to complete the VA 21-0960C-7 form online
- Press the ‘Get Form’ button to access the VA 21-0960C-7 form and open it in your chosen online platform.
- Begin by entering the patient or veteran's name and social security number in the specified fields.
- Proceed to Section I: Diagnosis. Indicate whether the veteran has been diagnosed with fibromyalgia by selecting 'Yes' or 'No.' If 'Yes,' complete the additional fields regarding conditions and diagnoses.
- In Section II: Medical Record Review, specify which medical records were reviewed in preparation for the report.
- Move to Section III: Medical History. Describe the history of the veteran's fibromyalgia condition and answer questions regarding medication and current treatment.
- In Section IV: Findings, Signs and Symptoms, record any findings or symptoms that are attributable to fibromyalgia, including checking off any applicable conditions.
- Continue to Section V: Other Pertinent Physical Findings. Indicate if there are any other conditions or symptoms related to the fibromyalgia.
- Next, complete Section VI: Diagnostic Testing by noting any significant diagnostic test findings.
- Fill Section VII: Functional Impact. Indicate if the fibromyalgia impacts the veteran's ability to work and provide examples if applicable.
- Lastly, review Section IX: Physician's Certification and Signature. Ensure the physician completes their contact information, signature, and certifies the accuracy of the information provided.
- Once completed, you can save your changes, download, print, or share the form as needed.
Submit the VA 21-0960C-7 form online to ensure timely processing of your disability claim.
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When answering DBQ questions for VA disability, be honest and precise about your symptoms and limitations. Provide detailed descriptions supported by medical records and evidence. Make sure to refer to the VA 21-0960C-7, as it helps outline the necessary medical information to bolster your answers.
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