Get the free VA Form 21-0960G-4(2-11). Intestinal Surgery (bowel resection, colostomy and ileostomy)

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OMB Approved No. 29000778 Respondent Burden: 15 minutesINTESTINAL SURGERY (BOWEL RESECTION, COLOSTOMY, ILEOSTOMY) DISABILITY BENEFITS QUESTIONNAIRE IMPORTANT THE DEPARTMENT OF VETERANS AFFAIRS (VA)

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How to fill out va form 21-0960g-42-11 intestinal

01

Start by downloading VA Form 21-0960G-42-11 Intestinal from the official VA website or obtain a physical copy from your local VA office.

02

Read the instructions provided with the form carefully to understand the information you need to gather and the sections you need to complete.

03

Begin filling out the form by providing your personal information, such as your name, social security number, and contact details.

04

Next, provide details about your medical condition related to the intestines. This may include information about any symptoms, diagnoses, treatments, medications, surgeries, or ongoing medical care you have received.

05

If applicable, provide information about any related injuries or events that led to your intestinal condition.

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Include details about any activities or functions that you are unable to perform as a result of your intestinal condition.

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Be sure to provide accurate and complete information to the best of your knowledge. If you are unsure about any details, consult your healthcare provider or medical records for assistance.

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Review the completed form to ensure all sections are filled out correctly and there are no errors or omissions.

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Sign and date the form to attest to the accuracy of the information provided.

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Make a copy of the completed form for your records before submitting it to the appropriate VA office.

Who needs va form 21-0960g-42-11 intestinal?

01

VA Form 21-0960G-42-11 Intestinal is needed by individuals who are seeking disability compensation or benefits from the Department of Veterans Affairs (VA) for a medical condition related to the intestines. This form is specifically designed for veterans or service members who have experienced intestinal disorders or diseases and are requesting VA disability benefits for this condition.

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