Get the free VA Form 21-0960M-4. Elbow and Forearm - Disability Benefits Questionnaire - csupomona
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THE BAKERSFIELD CALIFORNIA STATE UNIVERSITY O F IC E O F TH E C HA N C E L LO R June 3, 2014, CHANNEL ISLANDS MEMORANDUM CHICO DOMINGUEZ HILLS CSU Presidents FROM: Timothy P. White Chancellor SUBJECT:
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How to fill out va form 21-0960m-4 elbow
How to fill out VA Form 21-0960M-4 Elbow:
01
Start by filling out the personal information section at the top of the form. Provide your full name, address, phone number, and Social Security number.
02
Next, provide your veteran identification information. Include your VA file number, branch of service, and period of service.
03
Indicate the specific condition you are claiming or seeking an increase in compensation for, related to the elbow. Provide a detailed description of the symptoms, the date of diagnosis, and any treatment received.
04
If you have had any surgeries or medical procedures related to your elbow condition, specify the type of procedure, the date it was performed, and the name of the facility or doctor who performed it.
05
Provide a comprehensive list of all current medications you are taking for your elbow condition. Include the name of the medication, the dosage, and how frequently you take it.
06
If you have any medical records or supporting documentation related to your elbow condition, you may attach them to the form. Be sure to label and organize the documents properly for easy reference.
07
Sign and date the form at the bottom to certify the information provided is true and accurate to the best of your knowledge. If you are filling out the form on behalf of the veteran, include your name, relationship to the veteran, and contact information.
Who needs VA Form 21-0960M-4 Elbow?
01
Veterans who have a service-connected elbow condition and are seeking compensation or an increase in compensation for that specific condition.
02
Veterans who have undergone surgeries or medical procedures related to their elbow condition.
03
Veterans who are currently taking medications for their elbow condition.
Note: It is always recommended to consult with a Veterans Service Officer or legal representative for assistance in filling out VA forms to ensure accurate and complete submission.
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