Get the free VA Form 21-0960M-1. Amputations - Disability Benefits Questionnaire

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OMB Approved No. 2900-0776 Respondent Burden: 30 minutes AMPUTATIONS DISABILITY BENEFITS QUESTIONNAIRE IMPORTANT THE DEPARTMENT OF VETERANS AFFAIRS (VA) WILL NOT PAY OR REIMBURSE ANY EXPENSES OR COST

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How to fill out va form 21-0960m-1 amputations

How to fill out VA Form 21-0960M-1 Amputations:

01

Begin by carefully reading the instructions provided on the form. It is essential to understand the purpose of the form and the information that needs to be provided accurately.

02

Section I: Personal Information

2.1

Fill in your name, address, Social Security number, and contact information in the designated fields.

03

Section II: Veteran's Claim Information

3.1

Provide details regarding your veteran status, including service branch, service dates, and VA file number, if applicable.

04

Section III: Limb Loss Information

4.1

Indicate the type of amputation you experienced, whether it is a single or multiple limb loss. Specify the exact affected body part(s) and provide details about any residual limb conditions.

05

Section IV: Medical Providers

5.1

List all the healthcare professionals involved in your amputation treatment, including names, addresses, and contact information. Include both primary care providers and specialists.

06

Section V: Additional Medical History

6.1

Provide details about any previous amputations, complications, or related conditions. This may include information about prosthetics, ongoing rehabilitation, or other relevant medical facts.

07

Section VI: Employment Impact

7.1

Explain how your amputation(s) have affected your ability to work or seek employment. Detail any limitations, accommodations needed, or vocational rehabilitation services you have received or are currently receiving.

08

Section VII: Remarks

8.1

Use this section to include any additional information or explanation related to your amputations. This can be used to clarify specific points or provide context for your claim.

Who needs VA Form 21-0960M-1 Amputations?

01

This form is typically required for veterans who have experienced amputations and are seeking disability benefits from the Department of Veterans Affairs (VA).

02

It is also necessary for individuals who have already submitted other related disability claim forms (such as VA Form 21-526EZ) and need to provide specific information regarding their amputations.

Note: It is advisable to consult with a Veterans Service Officer or a VA representative if you have any doubts or questions while filling out this form. They can provide guidance and ensure that all necessary information is included accurately.

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What is va form 21-0960m-1 amputations?

VA Form 21-0960M-1 is used to evaluate and report on amputations for disability compensation.

Who is required to file va form 21-0960m-1 amputations?

Veterans who have experienced amputations and are seeking disability compensation from the VA are required to file VA Form 21-0960M-1.

How to fill out va form 21-0960m-1 amputations?

VA Form 21-0960M-1 must be completed with detailed information about the amputation, including date of amputation, affected body part, and any limitations or complications resulting from the amputation.

What is the purpose of va form 21-0960m-1 amputations?

The purpose of VA Form 21-0960M-1 is to gather relevant information about an individual's amputation in order to determine eligibility for disability compensation.

What information must be reported on va form 21-0960m-1 amputations?

VA Form 21-0960M-1 requires information such as date of amputation, details of the amputated body part, current limitations or complications related to the amputation, and any relevant medical history.

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