Get Va 21-0960a-1 2014-2025

Completing the VA 21-0960A-1 form is essential for veterans seeking disability benefits related to ischemic heart disease. This guide provides clear instructions on effectively filling out the form online to ensure accurate submission.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the form and open it in your chosen editor.
2. Enter the name of the patient or veteran as it appears in official documents.
3. Provide the patient or veteran's social security number to ensure proper identification.
4. In Section I, indicate whether the veteran has ischemic heart disease by selecting 'Yes' or 'No' and listing any diagnoses along with their ICD codes and dates.
5. For Section II, check if the veteran's treatment plan includes taking continuous medication for the diagnosed condition and list any prescribed medications.
6. In this section, report any history of significant cardiac events by checking the applicable boxes and providing treatment facility names and dates.
7. For Section III, specify if the veteran has congestive heart failure (CHF) and whether it is chronic, including episodes within the past year.
8. In Section IV, note whether a diagnostic exercise test has been conducted and provide the level of METs the veteran can perform, along with the test date.
9. Proceed to Section V and indicate if there is evidence of cardiac hypertrophy or dilatation, providing dates for any diagnostic tests performed.
10. In Section VI, assess whether the ischemic heart disease impacts the veteran's ability to work and provide remarks as necessary.
11. Finalize the form in Section VII by having the physician certify and sign the document, including their printed name, medical license number, phone number, date signed, and address.
12. Once all sections are completed, save the changes to the form, and download, print, or share it as needed for submission.

Begin completing your VA 21-0960A-1 form online today to facilitate your application for benefits.