VA 21-0960N-1 2016 free printable template
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OMB Control No. 29000778 Respondent Burden: 15 Minutes Expiration Date: 09/30/2019 EAR CONDITIONS (INCLUDING VESTIBULAR AND INFECTIOUS CONDITIONS) DISABILITY BENEFITS QUESTIONNAIRE IMPORTANT THE DEPARTMENT
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How to fill out VA 21-0960N-1
01
Download the VA Form 21-0960N-1 from the VA website.
02
Read the instructions at the top of the form carefully.
03
Fill out the veteran's personal information in section I, including name, Social Security number, and date of birth.
04
In section II, indicate whether you are submitting the form for a new claim or an existing condition.
05
Provide details about the medical condition in section III, including diagnosis date and treatment history.
06
Fill in section IV with information regarding the impact of the condition on daily activities and employment.
07
Review the completed form to ensure all information is accurate and legible.
08
Sign and date the form at the bottom in section V.
Who needs VA 21-0960N-1?
01
Veterans applying for disability benefits related to a specific medical condition or service-connected issue.
02
Veterans seeking to provide updated information about an existing claim.
03
Medical professionals who are assisting veterans in documenting their conditions for VA benefits.
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What is VA 21-0960N-1?
VA Form 21-0960N-1 is a Department of Veterans Affairs form used to assess the severity of a Veteran's specific medical condition related to their claim for benefits.
Who is required to file VA 21-0960N-1?
Veterans who are seeking disability benefits for specific medical conditions may be required to file VA Form 21-0960N-1 as part of their claims process.
How to fill out VA 21-0960N-1?
To fill out VA Form 21-0960N-1, individuals must provide personal information, details about the medical condition, treatment history, and any relevant medical evidence to support their claim.
What is the purpose of VA 21-0960N-1?
The purpose of VA Form 21-0960N-1 is to document and evaluate the functional impacts of a Veteran's medical condition, which is necessary for determining eligibility for disability compensation.
What information must be reported on VA 21-0960N-1?
The information that must be reported on VA Form 21-0960N-1 includes the Veteran's identifying information, details about the medical condition, symptoms, duration and frequency of symptoms, and information regarding any treatments received.
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