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OMB Control No. 2900-0776 Respondent Burden: 30 minutes DIABETIC PERIPHERAL NEUROPATHY (DIABETIC SENSORY-MOTOR PERIPHERAL NEUROPATHY) DISABILITY BENEFITS QUESTIONNAIRE IMPORTANT THE DEPARTMENT OF
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How to fill out va form 21-0960c-4
How to fill out VA Form 21-0960C-4:
01
Start by carefully reviewing the form and its instructions. Make sure you understand the purpose of the form and the information it requires.
02
Begin by providing your personal information in section 1. This includes your full name, social security number, and contact information.
03
In section 2, you will need to provide details about the specific medical condition you are claiming. Be thorough and accurate in describing your condition and any symptoms or limitations it causes. If you are filing for multiple conditions, make sure to list them all.
04
If you have received medical treatment or evaluation related to your condition, provide the necessary information in section 3. Include the names and contact information of the healthcare providers or facilities, along with the dates of treatment or evaluation.
05
Section 4 requires you to provide information about any diagnostic testing or imaging you have undergone for your condition. Include the types of tests, the names of the facilities where they were performed, and the dates of the tests.
06
If you have been prescribed medications for your condition, list them in detail in section 5. Include the names of the medications, the prescriber's name and contact information, and the dates of prescription.
07
Section 6 is for additional remarks or information. Use this space to provide any additional details that may be relevant to your claim.
08
Review the completed form carefully to ensure all the required information has been provided accurately. Make sure to sign and date the form in section 9.
Who needs VA Form 21-0960C-4:
01
Veterans who are applying for disability compensation from the Department of Veterans Affairs (VA) and are claiming a specific medical condition or disability.
02
Individuals who have been diagnosed with a medical condition related to their military service and are seeking financial assistance or benefits from the VA.
03
Veterans who have undergone medical treatment, evaluation, or testing for a specific condition and need to provide documentation to support their disability claim.
It is important to note that only veterans who meet certain eligibility criteria and have been honorably discharged from military service are eligible to apply for VA disability compensation.
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