Get Va Form 21-0960a-4 2014-2025

Filling out VA Form 21-0960A-4, the heart conditions disability benefits questionnaire, can be a straightforward process if you follow the right steps. This guide is designed to provide clear and supportive instructions, making it easier for you to complete the form accurately online.

Follow the steps to successfully complete your VA Form 21-0960A-4.

1. Click ‘Get Form’ button to download the form and access it online.
2. Begin by entering the name of the patient or veteran in the designated field at the top of the form. This is crucial for identifying the information provided.
3. Next, input the patient or veteran's social security number. Ensure the number is correct, as it will be used to verify the applicant's identity.
4. In Section I, diagnose whether the veteran currently has or has ever been diagnosed with a heart condition by selecting 'Yes' or 'No.' If 'Yes,' proceed to check all relevant heart conditions listed in Item 1B.
5. For each heart condition checked, provide the ICD Code and the date of diagnosis in the appropriate fields that follow each condition.
6. In Section II, provide a brief summary of the history of the veteran's heart conditions, including onset and course in Item 2A.
7. If applicable, indicate whether any of the veteran's heart conditions qualify as ischemic heart disease in Item 2B. If 'Yes,' list the qualifying conditions.
8. Continue through each section, filling out items regarding medical history, myocardial infarction details, congestive heart failure status, arrhythmias, heart valve conditions, and any other relevant medical information.
9. Once all sections are completed, review all entries carefully for accuracy and completeness. Check for any required signatures in Section XVII from the physician verifying the information.
10. After verifying the form, save your changes using the options provided in the editor. You can then download or print the completed form for submission.

Complete your VA Form 21-0960A-4 online today to ensure your application is processed smoothly.