Get Va 21-0960n-1 2016-2025

The VA 21-0960N-1 form is an essential document for veterans seeking disability benefits related to ear conditions. This guide will help you navigate the process of filling out the form online with clarity and support.

Follow the steps to successfully fill out the VA 21-0960N-1 form.

1. Press the ‘Get Form’ button to access the form and open it in your browser.
2. Begin with the patient/veteran's information section, ensuring you enter their full name and social security number accurately.
3. In Section I, indicate whether the veteran has been diagnosed with an ear or peripheral vestibular condition by selecting 'Yes' or 'No.' If 'Yes,' provide details about the specific condition in the following fields.
4. Complete Section II by summarizing the history of the veteran's ear or peripheral vestibular conditions. State the onset and progression of these conditions.
5. In Section III, indicate if the veteran has symptoms associated with Meniere's syndrome or other conditions by selecting 'Yes' or 'No.' If 'Yes,' check all applicable symptoms and provide details.
6. Proceed to Section IV to detail any infectious conditions, where you will again confirm the presence of symptoms related to chronic infections or other conditions.
7. The next section, Section V, covers any surgical treatments the veteran has undergone. Indicate if there has been surgery and describe any resulting issues.
8. In Section VI, perform a physical exam and document findings for the external ear, ear canal, tympanic membrane, and related tests. Ensure the data you enter reflects current conditions.
9. Section VII focuses on tumors and neoplasms. Select 'Yes' or 'No' to confirm if there are any related conditions and provide detailed descriptions as needed.
10. In Section VIII, record any other pertinent physical findings or symptoms that impact the veteran's conditions.
11. For Section IX, if applicable, note any diagnostic testing conducted and summarize results to ensure proper ongoing treatment.
12. Complete Section X by describing how the veteran's conditions may impact their ability to work, providing specific examples.
13. Finally, use Section XI for any additional remarks and complete Section XII with the physician's certification, including their signature, name, and contact information.
14. Once all sections are filled out, review the form for accuracy. Save changes, and choose from options to download, print, or share the completed form.

Start filling out your documents online to facilitate your claim process.