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JAN 2011. 21-0960A-2. ARTERY AND VEIN CONDITIONS (VASCULAR DISEASES INCLUDING VARICOSE VEINS). DISABILITY BENEFITS QUESTIONNAIRE.

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How to fill out va form 21-0960a-212-10

How to fill out VA Form 21-0960A-212-10:

01

Start by downloading the VA Form 21-0960A-212-10 from the official website of the U.S. Department of Veterans Affairs. This form is specifically used for veterans who are filing a claim for disability compensation for post-traumatic stress disorder (PTSD) related to personal assault.

02

Read the instructions provided with the form carefully. It is essential to understand all the requirements and specific sections that need to be completed.

03

Begin filling out the form by providing your personal information. This includes your full name, social security number, date of birth, and contact details. Ensure the information provided is accurate and up to date.

04

The next section of the form requires you to provide the details of the traumatic event or events that caused your PTSD. Be as detailed as possible, explaining when and where the incident occurred, who was involved, and any other relevant information.

05

Moving forward, provide information about the behavioral effects you have experienced as a result of the traumatic event. This includes any changes in your mood, sleep patterns, relationships, concentration, and any other symptoms you may be experiencing.

06

The next section focuses on your medical and mental health history. It is essential to provide accurate information about any previous diagnosis, treatment, or medications related to PTSD or other mental health conditions.

07

If you have sought treatment for your PTSD, provide information about the healthcare providers you have seen, including their names, addresses, and contact details. Additionally, provide details of any medications you are taking or have taken for your condition.

08

The last section of the form requires you to sign and date it. Ensure that you have completed all the necessary sections before submitting the form.

Who needs VA Form 21-0960A-212-10?

The VA Form 21-0960A-212-10 is specifically designed for veterans who are filing a claim for disability compensation for post-traumatic stress disorder (PTSD) related to personal assault. This form is essential for individuals who have experienced traumatic events during their military service that have resulted in PTSD symptoms.

It is important for those veterans who believe they are eligible for compensation due to PTSD from personal assault to fill out this form accurately and provide all the necessary information. Submitting the completed form provides the VA with the required documentation to evaluate and process the claim.

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What is va form 21-0960a-212-10?

Va form 21-0960a-212-10 is the form used by veterans to apply for increased disability compensation based on unemployability.

Who is required to file va form 21-0960a-212-10?

Veterans who believe that their service-connected disabilities prevent them from maintaining gainful employment are required to file va form 21-0960a-212-10.

How to fill out va form 21-0960a-212-10?

Va form 21-0960a-212-10 can be filled out by providing information about the veteran's employment history, medical conditions, and treatment records. It is important to be thorough and accurate when filling out this form.

What is the purpose of va form 21-0960a-212-10?

The purpose of va form 21-0960a-212-10 is to request an assessment of a veteran's eligibility for increased disability compensation due to unemployability.

What information must be reported on va form 21-0960a-212-10?

Information such as the veteran's employment history, medical conditions, treatment records, and details about how the disabilities impact the ability to maintain gainful employment must be reported on va form 21-0960a-212-10.

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