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OMB Approved No. 2900-0778 Respondent Burden: 15 minutes BREAST CONDITIONS AND DISORDERS DISABILITY BENEFITS QUESTIONNAIRE IMPORTANT THE DEPARTMENT OF VETERANS AFFAIRS (VA) WILL NOT PAY OR REIMBURSE
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How to fill out va form 21-0960m-4
How to fill out VA Form 21-0960M-4:
01
Access the VA Form 21-0960M-4 from the official VA website or obtain a physical copy from your local VA office.
02
Read the instructions provided on the form carefully to understand the purpose and requirements.
03
Fill in the personal information section: Provide your full name, date of birth, Social Security number, and other requested identification details.
04
In the "Purpose of Examination" section, specify the reason for seeking this particular form, such as a disability claim or medical evaluation.
05
The next section deals with medical history. Answer all questions truthfully and accurately, providing relevant details about your medical conditions, treatments, and any related medications.
06
If you have undergone previous medical examinations or treatment related to the same or similar condition, provide the necessary information in the "Prior Examinations or Treatment" section.
07
If you are currently receiving any disability benefits, specify the details in the "Present Benefits" section.
08
If there are any additional remarks or comments you wish to include, you can provide them in the "Remarks" section.
09
Review the form once completed to ensure all fields are filled accurately and appropriately.
10
Sign and date the form in the designated areas.
11
Submit the filled-out form as instructed, either by mailing it to the specified VA address or submitting it electronically if applicable.
Who needs VA Form 21-0960M-4:
01
Veterans seeking disability benefits from the VA may need to fill out VA Form 21-0960M-4.
02
Individuals who have specific medical conditions that require evaluation or documentation for VA disability claims may also need to use this form.
03
The form is typically used by veterans who want to apply for or update their disability ratings or seek medical assessments related to their service-connected disabilities.
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What is va form 21-0960m-4?
VA Form 21-0960M-4 is a form used by the Department of Veterans Affairs (VA) to evaluate a veteran's mental health condition for disability benefits.
Who is required to file va form 21-0960m-4?
Veterans who are seeking disability benefits for a mental health condition are required to file VA Form 21-0960M-4.
How to fill out va form 21-0960m-4?
To fill out VA Form 21-0960M-4, you should provide your personal information, details about your mental health condition, and any supporting medical documentation. It is recommended to seek assistance from a VA representative or healthcare provider to ensure accurate completion.
What is the purpose of va form 21-0960m-4?
The purpose of VA Form 21-0960M-4 is to gather information necessary for the VA to evaluate and determine eligibility for disability benefits related to mental health conditions.
What information must be reported on va form 21-0960m-4?
VA Form 21-0960M-4 requires reporting of personal information, medical history, symptoms, treatments received, impact on daily life activities, and any supporting documentation related to the mental health condition being claimed.
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