Get Va Form 21-0960h-1 2016-2025

Filling out the VA Form 21-0960H-1, the Disability Benefits Questionnaire for hernias, is an essential step for veterans seeking disability benefits. This guide provides clear, step-by-step instructions to assist users in accurately completing the form online.

Follow the steps to successfully complete the VA Form 21-0960H-1.

1. Click 'Get Form' button to obtain the VA Form 21-0960H-1. This will open the form for you to fill out online.
2. Begin by entering the name of the patient or veteran in the designated field. This information is crucial for identifying the individual related to the claim.
3. Input the patient or veteran's social security number in the appropriate field to ensure accurate processing of the claim.
4. In Section I, diagnosis, indicate if the veteran currently has or has ever had any hernia conditions by selecting 'Yes' or 'No'. If 'Yes', complete the specified items regarding the type of hernia and relevant diagnosis details, including ICD codes and dates of diagnosis.
5. Proceed to Section II to indicate which medical records were reviewed in preparation for this report. You can specify whether the C-file or other medical records were used.
6. Describe the medical history related to the hernia in Section III, including any continuous medication required and a brief summary of the history of the hernia conditions.
7. For Section IV, complete details about the different types of hernias present, including surgical statuses, exams, and indications for support as applicable. Be sure to check all relevant boxes.
8. In Section V, provide information regarding any pertinent physical findings, scars, complications, or other conditions related to the diagnosis. Respond 'Yes' or 'No' and offer details if relevant.
9. In Section VI, indicate whether there are any significant diagnostic test findings and provide brief descriptions as necessary.
10. Section VII requires you to specify any impact the hernia conditions have on the ability to work. Describe the impact with relevant examples if applicable.
11. Use Section VIII for any additional remarks that may be pertinent to the claim.
12. Finally, Section IX is for the physician's certification and signature. Ensure the physician provides their signature, printed name, phone numbers, NPI number, date signed, and address.
13. Once completed, you can save changes, download the form, print it, or share it as necessary to ensure submission.

Complete the VA Form 21-0960H-1 online today to streamline your application for disability benefits.