Get Va 21-0960j-1 2018-2025

Filling out the VA 21-0960J-1 form is an important step for veterans seeking disability benefits related to kidney conditions. This guide provides clear and detailed instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete the VA 21-0960J-1 form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online format.
2. Begin by entering the name of the patient or veteran in the designated field at the top of the form.
3. In the next field, provide the patient or veteran's social security number for identification purposes.
4. Move on to Section I - Diagnosis. Answer whether the veteran has or has ever been diagnosed with a kidney condition by selecting 'Yes' or 'No'. If 'Yes', complete Item 1B by checking all applicable diagnoses and providing the corresponding ICD codes and dates of diagnosis.
5. Proceed to Section II - Medical History. Describe the patient's current kidney condition, including its history, cause, onset, and course. Indicate if continuous medication is part of the treatment plan and list any medications in the provided field.
6. In Section III - Renal Dysfunction, confirm whether the veteran has renal dysfunction. Answer the following questions based on their condition, indicating additional treatment requirements if necessary.
7. Continue to Section IV - Urolithiasis. Indicate if the veteran has a history of kidney stones. If applicable, describe the treatment undertaken and any symptoms present.
8. In Section V - Infections, indicate if the veteran has recurrent urinary tract or kidney infections, providing details about the etiology and treatment used.
9. Fill out Section VI - Kidney Transplant or Removal as needed by answering questions regarding previous kidney removal or transplantation.
10. Complete Section VII - Tumors and Neoplasms by stating if any related neoplasms are present and detailing the type of treatment received.
11. In Section VIII - Other Pertinent Physical Findings, indicate if the veteran has any scars or other physical findings relevant to their kidney condition.
12. Fill out Section IX - Diagnostic Testing, including details of any laboratory tests performed and their results.
13. Section X - Functional Impact requires you to detail how the veteran's kidney conditions affect their ability to work.
14. Provide any additional remarks in Section XI that may aid in the evaluation of the claim.
15. Complete Section XII with the physician's certification. The physician must print their name, sign, and date the form, and provide their contact information.
16. Once all sections are completed, you can save changes, download the filled form, print it, or share it as needed.

Complete your VA 21-0960J-1 form online today to ensure your application is submitted without delay.