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3A. INITIAL ROM MEASUREMENTS BACK All Normal Joint Movement ROM Measurement Forward Flexion normal endpoint 90 degrees Not indicated Extension Right Lateral Flexion Left Lateral Rotation VA FORM 21-0960M-14 MAY 2013 If ROM testing is not indicated for the veteran s condition or not able to be performed please explain why and then proceed to Section 5 Not able to perform Page 2 3B. Explain your findings and reasons in comments section. Mechanical back pain syndrome ICD Code Date of diagnosis Lumbosacral sprain/strain Facet joint arthropathy Degenerative disc disease Foraminal/lateral recess/ central stenosis Spondylolysis/isthmic spondylolisthesis degenerative joint disease of lumbosacral spine Intervertebral disc syndrome Radiculopathy Ankylosis of thoracolumbar spine Ankylosing spondylitis of the thoracolumbar spine back NOTE If there are systemic or other constitutional manifestations of ankylosing spondylitis ALSO complete the Non-degenerative Arthritis DBQ and the appropriate DBQ f....

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How to fill out the VA 21-0960M-14 online

The VA 21-0960M-14 form, also known as the back (thoracolumbar spine) conditions disability benefits questionnaire, is a crucial document for veterans applying for disability benefits. This guide provides detailed instructions on how to complete the form online, ensuring that users can navigate each section efficiently.

Follow the steps to successfully complete the VA 21-0960M-14 online.

  1. Use the ‘Get Form’ button to access the VA 21-0960M-14 form and open it in your online editor.
  2. Begin by entering the name of the patient or veteran in the specified field. Ensure that the name matches the records.
  3. Input the veteran's social security number in the designated area. This information is vital for identification purposes.
  4. Move to the section titled 'Medical record review.' Indicate whether the claims file was reviewed. If yes, list any relevant records that were not included in the claims file.
  5. In Section I, you will identify the diagnosis. List all claimed conditions and select the appropriate diagnoses from the given options.
  6. Provide a brief summary of the medical history related to the veteran's thoracolumbar spine condition in Section II.
  7. Proceed to document the initial range of motion (ROM) measurements in Section III, utilizing a goniometer to ensure accurate readings.
  8. In Section IV, report any additional ROM limitations noticed after performing repetitive use testing.
  9. Complete Section V by indicating any painful movements observed and the impact those movements may have on functional capabilities.
  10. Continue through the form, documenting details in sections VI through XIII to assess muscle strength, reflexes, neurological abnormalities, and any other pertinent findings.
  11. Upon finishing all sections, review your entries for accuracy and completeness. You can then save changes, download, print, or share the form.

Complete your VA 21-0960M-14 form online today to streamline your disability benefits application process.

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