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Get Va 21-0960a-3 2012
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How to fill out the VA 21-0960A-3 online
The VA 21-0960A-3 form is an essential document used to assess disability benefits related to hypertension. This guide provides step-by-step instructions to support users in accurately completing the form online.
Follow the steps to successfully fill out the VA 21-0960A-3 online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Enter the name of the patient or veteran in the specified field. Ensure you include their full legal name as it appears in official records.
- Provide the patient or veteran's Social Security number in the designated area. This is crucial for proper identification of the individual in the system.
- Proceed to Section I - Diagnosis. Here, indicate whether the veteran has been diagnosed with hypertension or isolated systolic hypertension by selecting 'Yes' or 'No.' If 'Yes,' list relevant diagnoses and their corresponding ICD codes.
- In Section II - Medical History, summarize the onset and course of the veteran's hypertension. Then, indicate if their treatment plan includes continuous medication, and list any medications taken.
- Confirm if the initial diagnosis of hypertension was supported by blood pressure readings taken on multiple days. Record relevant blood pressure readings when applicable in this section.
- Move to Section III to detail any pertinent physical findings, scars, or complications related to the diagnosed condition. If applicable, follow the prompts regarding scars.
- In Section IV, assess and document the impact of hypertension on the veteran's ability to work. Provide specific examples of any limitations experienced.
- Complete Section V with any additional remarks that may support the claim.
- Finally, in Section VI, ensure that the physician's signature, printed name, phone and fax number, medical license number, and address are accurately filled out. Once complete, users can save changes, download, print, or share the form as needed.
Take the next step towards securing your benefits by completing the VA 21-0960A-3 form online today.
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Several conditions can automatically qualify you for VA disability, including certain chronic illnesses and conditions related to Agent Orange exposure. If you believe you have one of these conditions, complete the VA 21-0960A-3 form carefully, ensuring you provide all relevant information. Utilizing resources from platforms like USLegalForms can also help you navigate the application process more easily.
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