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OMB Approved No. 2900-0776 Respondent Burden: 30 minutes MUSCLE INJURIES DISABILITY BENEFITS QUESTIONNAIRE IMPORTANT THE DEPARTMENT OF VETERANS AFFAIRS (VA) WILL NOT PAY OR REIMBURSE ANY EXPENSES

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How to fill out va form 21-0960m-10

Point by point instructions for filling out VA Form 21-0960M-10:

01

Start by entering your personal information in Section I. This includes your name, Social Security number, date of birth, and contact information.

02

Move on to Section II, where you will provide details about the condition you are claiming. This includes the date of diagnosis, the name and address of the medical professional who diagnosed you, and a brief description of the condition.

03

In Section III, you will need to list all the medications you are currently taking for the claimed condition. Include the name of each medication, the dosage, and the frequency of use.

04

If you have received any examinations or treatments specifically related to the claimed condition, provide details in Section IV. Include the date and location of each examination or treatment, as well as the name and contact information of the healthcare provider who performed it.

05

In Section V, you will need to provide information about any other medical conditions that are related to or may impact the claimed condition. List the condition, provide a brief description, and indicate whether it is service-connected.

06

Section VI is where you will certify the accuracy and completeness of the information provided on the form. Read the certification statement carefully and sign and date the form.

Who needs VA Form 21-0960M-10?

VA Form 21-0960M-10 is required for veterans who are applying for disability compensation with the Department of Veterans Affairs (VA) and are claiming a mental health condition as the basis for their disability. This form specifically pertains to Mental Disorders, such as depression, anxiety, post-traumatic stress disorder (PTSD), and other related conditions.

It is important to note that VA Form 21-0960M-10 may need to be filled out by different individuals depending on the circumstances. Veterans who are filing a new claim, seeking an increase in their current disability rating, or appealing a previous decision may all need to complete this form. It is always recommended to consult with a VA representative or a Veterans Service Organization to ensure that you are filling out the correct form for your specific situation.

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What is va form 21-0960m-10?

The VA Form 21-0960M-10 is the Mental Disorders (other than PTSD and Eating Disorders) Disability Benefits Questionnaire.

Who is required to file va form 21-0960m-10?

Veterans who are claiming disability benefits for mental disorders other than PTSD and Eating Disorders are required to file VA Form 21-0960M-10.

How to fill out va form 21-0960m-10?

To fill out VA Form 21-0960M-10, the veteran should provide detailed information about their medical history, symptoms, and any treatment received for the mental disorder.

What is the purpose of va form 21-0960m-10?

The purpose of VA Form 21-0960M-10 is to gather necessary medical information to evaluate the veteran's claim for disability benefits related to mental disorders.

What information must be reported on va form 21-0960m-10?

The VA Form 21-0960M-10 requires the reporting of detailed medical history, symptoms, and treatment received for the mental disorder being claimed.

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