Get the free VA Form 21-0960D-1 - Veterans Benefits Administration - VA.gov

IF THE VETERAN HAS LOST ANY PART OF THE MAXILLA IS THE LOSS REPLACEABLE BY PROSTHESIS NOT APPLICABLE VA FORM 21-0960D-1 MAR 2011 Page 2 Malunion or nonunion with slight displacement PART C - TEETH INCLUDING ANATOMICAL LOSS OR BONY INJURY LEADING TO LOSS OF ANY TEETH OTHER THAN THAT DUE TO THE LOSS OF THE ALVEOLAR PROCESS AS A RESULT OF PERIODONTAL DISEASE 1. INDICATE MEDICAL RECORDS REVIEWED IN PREPARATION OF THIS REPORT C-file VA only Other describe 3. MEDICAL/DENTAL HISTORY including onset...

How to fill out va form 21-0960d-1

How to fill out VA Form 21-0960D-1:

1. Start by carefully reading the instructions provided on the form. It is essential to understand the purpose of the form and the information required.
2. Begin by entering your personal information in Section I of the form. This includes your name, social security number, date of birth, and contact information.
3. In Section II, provide the details of your healthcare provider who is completing the form. Include their name, address, and phone number.
4. Move on to Section III, where you need to provide information about your illness, injury, or event that led to the claimed condition. This includes the date of onset, location, and a description of the condition.
5. If applicable, complete Section IV to provide details of any treatments you have received for the claimed condition. This may include medications, surgeries, therapies, or any other treatments.
6. In Section V, list any symptoms you experience as a result of the claimed condition. Be thorough and specific in describing how these symptoms affect your daily life.
7. If there are additional medical records or documentation related to the claimed condition, attach them in Section VI. This might include medical reports, test results, or statements from other healthcare providers.
8. Review the form carefully, ensuring that all the information provided is accurate and complete. Double-check for any missing or incorrect information before submitting the form.
9. Lastly, sign and date the certification statement in Section VII, acknowledging that the information you provided is true and correct to the best of your knowledge.

Who needs VA Form 21-0960D-1?

VA Form 21-0960D-1 is required for any veteran or service member who is seeking to claim disability compensation for post-traumatic stress disorder (PTSD) related to personal assault. This form is specifically designed to gather essential information about the condition, treatments, symptoms, and any other relevant details that will support the individual's claim. It is necessary for those who believe their PTSD is a result of personal assault to accurately complete and submit this form as part of the claims process for obtaining disability compensation benefits from the Department of Veterans Affairs (VA).

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