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OMB Approved No. 2900XXXX Respondent Burden: 15 minutesISCHEMIC HEART DISEASE (HD) DISABILITY BENEFITS QUESTIONNAIRE IMPORTANT PLEASE READ THE PRIVACY ACT AND RESPONDENT BURDEN INFORMATION ON REVERSE
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How to Fill Out 21-0960a Ischemic Heart Disease:

01
Begin by carefully reading the form: Start by reviewing the entire form 21-0960a for Ischemic Heart Disease. Familiarize yourself with the instructions, format, and any specific requirements mentioned.
02
Provide personal information: Fill in your personal details, including your name, date of birth, social security number, and contact information. Make sure all the information is accurate and up to date.
03
Mention your service information: Provide details about your military service, such as branch of service, dates of service, and discharge status if applicable. Include any relevant information about your assignments or deployments that may be relevant to your ischemic heart disease.
04
Explain your medical history: In the designated sections, provide a comprehensive account of your medical history related to ischemic heart disease. Include details about the diagnosis, symptoms, onset, treatment, and any hospitalizations or surgeries. Be thorough and concise in describing your condition.
05
List your medications and treatment: Document all the medications you are currently taking for your ischemic heart disease or any other related conditions. Specify the dosage, frequency, and duration of each medication. Additionally, mention any therapy or treatment you have undergone or are currently undergoing.
06
Include pertinent medical records: Attach any relevant medical records, test results, imaging reports, or other supporting documents that validate your diagnosis and treatment. These records can play a crucial role in the evaluation of your claim.
07
Provide additional information and remarks: Utilize the space provided to include any additional information or remarks that you believe are relevant to your case. This may include any difficulties you face in daily life due to your condition or any specific challenges you encounter.

Who Needs 21-0960a Ischemic Heart Disease?

01
Veterans with diagnosed ischemic heart disease: Individuals who have received a medical diagnosis of ischemic heart disease and are seeking compensation or benefits from the Department of Veterans Affairs (VA) should complete form 21-0960a.
02
Veterans filing a disability claim for ischemic heart disease: If you are a veteran dealing with ischemic heart disease and wish to file a disability claim with the VA, completing form 21-0960a is essential. This form serves as a crucial part of the claims process and helps the VA determine eligibility for benefits.
03
Veterans seeking an increase in disability rating for ischemic heart disease: For veterans who already have a disability rating for ischemic heart disease but believe their condition has worsened, form 21-0960a can be used to request a re-evaluation and potential increase in their disability rating.
Remember, it is always recommended to consult with a professional VA representative or seek guidance from a Veterans Service Organization (VSO) for assistance in accurately completing the form and understanding the claims process.
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21-0960a is a form used by the Department of Veterans Affairs (VA) to evaluate and rate ischemic heart disease in veteran claimants.
Veterans who are claiming disability benefits for ischemic heart disease are required to file form 21-0960a.
To fill out form 21-0960a, veterans need to provide detailed information about their medical history, symptoms, and any treatment received for their ischemic heart disease.
The purpose of form 21-0960a is to help the VA assess the severity of a veteran's ischemic heart disease and determine their eligibility for disability benefits.
Veterans must report information about their medical history, symptoms, treatments, medications, and any impact the disease has on their daily life.
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