Get Va 21-0960n-2 2018-2026

The VA 21-0960N-2 form is essential for veterans applying for eye conditions disability benefits. Completing this form accurately ensures that the Department of Veterans Affairs has the necessary information to evaluate your claim effectively.

Follow the steps to fill out the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the patient's or veteran's name in the designated field; ensure it matches the official records.
3. Input the veteran's Social Security Number in the corresponding section to assist with identification.
4. In Section I, after the clinician's examination, input the diagnosis of the eye condition(s). List the diagnosis, ICD code, and date for each condition.
5. Section II requires a brief summary of the medical history regarding the current eye condition; ensure accuracy and clarity.
6. Proceed to Section III, which encompasses visual acuity assessments. Record uncorrected and corrected vision for both eyes, selecting from the provided options.
7. In Section IV, check any eye conditions present, providing further details as required for each condition.
8. Continue through Sections V to VII, detailing any related scarring, incapacitating episodes, or functional impacts experienced due to eye conditions.
9. Finally, in Section IX, the optometrist or physician must certify and sign the document, ensuring all information is complete and accurate.
10. Upon completion, users can save changes, download, print, or share the form as necessary.

Take the next step towards filing your claim for disability benefits online.