VA Form 21-0960M-14 2010-2025 free printable template

OMB Approved No. 2900-0779 Respondent Burden: 45 minutes BACK (THORACOLUMBAR SPINE) CONDITIONS DISABILITY BENEFITS QUESTIONNAIRE IMPORTANT THE DEPARTMENT OF VETERANS AFFAIRS (VA) WILL NOT PAY OR REIMBURSE

How to fill out VA Form 21-0960M-14

How to fill out VA Form 21-0960M-14

1. Obtain VA Form 21-0960M-14 from the VA website or local VA office.
2. Begin by filling out the veteran's personal information at the top of the form including name, address, and Social Security number.
3. Indicate the condition for which you are seeking an evaluation, along with the date of diagnosis.
4. Provide detailed information on the severity and frequency of the symptoms or conditions, including any treatments you have received.
5. Include any relevant medical records or documents that support your claim.
6. Sign the form to certify that all information provided is accurate to the best of your knowledge.
7. Submit the completed form to the appropriate VA regional office or through the eBenefits portal.

Who needs VA Form 21-0960M-14?

1. Veterans who are seeking disability compensation related to a mental health condition, including PTSD, need VA Form 21-0960M-14.
2. The form is also required when the VA requests additional information regarding the severity of a veteran's mental health condition.

People Also Ask about

What is a thoracolumbar spine condition?

Thoracolumbar fractures are breakages in the vertebrae of the spinal column in the thoracic and lumbar regions. They may be associated with disruption of the ligamentous complexes, and can result in instability or compression of neural structures. Thoracolumbar fractures are the usual outcome of thoracolumbar trauma.

What are the symptoms of thoracolumbar dysfunction?

Clinical manifestations include back pain, pseudo-visceral pain and pseudo-pain on the posterior iliac crest, as well as irritable bowel symptoms. During clinical examination, pain can be demonstrated by applying pressure on the facet joints or to the sides of the spinous processes.

What is ankylosis of the entire thoracolumbar spine?

Unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing;

What is the VA rating for lumbosacral strain with degenerative disc disease?

§ 4.71a, Diagnostic Codes 5295- 5293. Lumbosacral strain is assigned a disability rating in the Schedule under Diagnostic Code 5295. Severe lumbosacral strain is given a 40 percent rating.

How do you treat thoracolumbar spine?

Usually, spinal fusion is performed as an operative treatment and in this procedure, the posterior approach is preferred than the anterior approach because most of the compression fractures do not have an involvement of the spinal canal. Short segment or long segment fusion may be chosen depending on the situation.

What is the maximum disability rating for degenerative disc disease?

What Is the Maximum Disability Rating for Degenerative Disc Disease? Despite how much pain the condition causes, the maximum VA disability rating for degenerative disc disease, as mentioned above, is typically 20 percent. However, there are a few ways veterans can increase their DDD VA rating.

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What is VA Form 21-0960M-14?

VA Form 21-0960M-14 is a form used by veterans to report their mental health conditions for the purpose of evaluating their eligibility for VA benefits.

Who is required to file VA Form 21-0960M-14?

Veterans who are seeking to establish or enhance their disability benefits related to mental health conditions are required to file VA Form 21-0960M-14.

How to fill out VA Form 21-0960M-14?

To fill out VA Form 21-0960M-14, veterans need to provide personal information, details about their mental health condition, any treatments received, and how their condition affects their daily life.

What is the purpose of VA Form 21-0960M-14?

The purpose of VA Form 21-0960M-14 is to enable the VA to assess the severity of a veteran's mental health condition, which is crucial for determining the level of benefits to which they are entitled.

What information must be reported on VA Form 21-0960M-14?

Information that must be reported on VA Form 21-0960M-14 includes the veteran's demographics, details about their mental health diagnosis, treatment history, and how their condition interferes with daily activities and employment.