Get the free VA Form 21-0960M-12. Shoulder and Arm Conditions - Disability Benefits Questionnaire

OMB Approved No. 2900-0776 Respondent Burden: 45 minutes EYE CONDITIONS DISABILITY BENEFITS QUESTIONNAIRE IMPORTANT THE DEPARTMENT OF VETERANS AFFAIRS (VA) WILL NOT PAY OR REIMBURSE ANY EXPENSES OR

How to fill out va form 21-0960m-12 shoulder

How to fill out VA Form 21-0960M-12 shoulder:

1. Start by entering your personal information in the designated sections of the form. This includes your name, social security number, date of birth, and contact information.
2. Next, provide details about your military service in the appropriate boxes. Include the branch of service, dates of service, and your service number or other identifying information.
3. The form requires you to describe your current condition or disability. Specify that you are seeking a claim for a shoulder-related issue or condition.
4. In the following sections, provide a comprehensive medical history related to your shoulder. Include any diagnosed conditions, injuries, surgeries, or treatments you have received in the past. Be sure to list any medications you are currently taking for your shoulder as well.
5. You will also need to provide information about any previous compensation or pension claims you have filed with the VA. Indicate whether you have previously claimed disability benefits for your shoulder or other related conditions.
6. If you have received any medical examinations or tests for your shoulder, provide details about the healthcare providers who conducted them, along with the dates and locations of the examinations.
7. In the following sections, you may be asked to provide additional information about specific symptoms or limitations related to your shoulder. Answer these questions honestly and thoroughly to provide a complete picture of your condition.
8. Finally, sign and date the form to certify the accuracy of the information provided.

Who needs VA Form 21-0960M-12 shoulder:

1. Veterans who are experiencing shoulder-related issues, injuries, or disabilities and wish to apply for disability benefits from the Department of Veterans Affairs (VA) may need to fill out VA Form 21-0960M-12.
2. Individuals who have served in the military and developed shoulder conditions or disabilities as a result of their service may benefit from completing this form to initiate a claim for compensation.
3. The form is necessary for those seeking VA disability benefits specifically related to shoulder conditions, including shoulder injuries, chronic pain, limited range of motion, arthritis, or any other shoulder-related disabilities recognized by the VA.

Note: It is always advisable to consult with a Veterans Service Organization (VSO) or an attorney who specializes in Veterans' Law for assistance in completing and submitting VA forms.

For pdfFiller’s FAQs

What is va form 21-0960m-12 shoulder?

The VA Form 21-0960M-12 Shoulder is a form used to evaluate and document disabilities related to shoulder conditions for veterans seeking compensation.

Who is required to file va form 21-0960m-12 shoulder?

Veterans who have shoulder conditions and are seeking disability compensation from the VA are required to file VA Form 21-0960M-12.

How to fill out va form 21-0960m-12 shoulder?

To fill out VA Form 21-0960M-12 Shoulder, veterans should provide all requested information about their shoulder condition, medical history, and any impact on daily activities.

What is the purpose of va form 21-0960m-12 shoulder?

The purpose of VA Form 21-0960M-12 Shoulder is to help the VA accurately evaluate and determine disability compensation for veterans with shoulder conditions.

What information must be reported on va form 21-0960m-12 shoulder?

Information regarding the shoulder condition, symptoms, treatments received, medical history, and how it affects daily activities must be reported on VA Form 21-0960M-12.

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