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OMB Approved No. 2900-0781 Respondent Burden: 30 minutes SYSTEMIC LUPUS ERYTHEMATOUS (SHE) AND OTHER AUTOIMMUNE DISEASES DISABILITY BENEFITS QUESTIONNAIRE IMPORTANT- THE DEPARTMENT OF VETERANS AFFAIRS
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How to fill out VA Form 21-0960N-4:

01
Start by carefully reading the instructions provided on the form. This will give you a helpful overview of the purpose and requirements of the form.
02
Begin filling out the form by entering the requested personal information such as your name, Social Security number, and contact information. Ensure that all information is accurate and up to date.
03
Proceed to Section I: Claimant Information. Provide details about your military service, including your branch of service, service dates, and any previous VA claims you have submitted. Be as thorough as possible to ensure accurate evaluation of your claim.
04
In Section II: Medical History, document your medical conditions for which you are seeking VA disability benefits. Provide comprehensive information about each condition, including the date of diagnosis and any treatments or medications you are currently receiving. Be sure to include all relevant medical documents, such as medical records and test results, to support your claims.
05
Move on to Section III: Employment History. Fill in details about your past employment, including job titles, employers, and dates of employment. Providing this information helps the VA evaluate the impact of your medical conditions on your ability to work.
06
If applicable, complete Section IV: Information About Your Work Status. This section is specifically for those who are currently employed but claiming disability benefits. Include details about your current job and any accommodations or restrictions you require due to your medical conditions.
07
Finally, review your completed form to ensure all information is accurate and complete. Be sure to sign and date the form, as well as provide any additional documents or evidence requested.

Who needs VA Form 21-0960N-4:

01
Veterans who are seeking disability benefits from the Department of Veterans Affairs.
02
Individuals who have medical conditions that they believe are related to their military service and may qualify for VA disability benefits.
03
Those who have already submitted a claim for disability benefits and have been instructed to complete this specific form to provide additional medical or employment information.
It is important to note that the specific requirements for using this form may vary. Individuals should always consult with a VA representative or review the instructions provided with the form to ensure they are using the correct form and completing it accurately.
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The VA Form 21-0960N-4 is the Application for Increased Compensation Based on Unemployability.
Veterans who are seeking increased compensation based on unemployability are required to file VA Form 21-0960N-4.
VA Form 21-0960N-4 can be filled out by providing personal and medical information, employment history, and details about the veteran's disabilities.
The purpose of VA Form 21-0960N-4 is to apply for increased compensation benefits based on unemployability for veterans.
Information such as personal details, medical history, employment information, and details about the veteran's disabilities must be reported on VA Form 21-0960N-4.
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