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OMB Control No. 2900-0778 Respondent Burden: 15 minutes GALLBLADDER AND PANCREAS CONDITIONS DISABILITY BENEFITS QUESTIONNAIRE IMPORTANT THE DEPARTMENT OF VETERANS AFFAIRS (VA) WILL NOT PAY OR REIMBURSE
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How to fill out va form 21-0960g-2

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How to fill out VA Form 21-0960G-2:

01
Begin by entering your personal information in the "Veteran's Identification Information" section, including your full name, Social Security number, date of birth, and contact information.
02
In the "Claimant's Identification Information" section, provide the necessary details if someone else is submitting the form on your behalf. Otherwise, leave this section blank.
03
The next section is "Medical Provider Information." Fill in the name, address, and contact details of the healthcare provider who performed the examination related to your claim.
04
Proceed to the "Claim Information" section and provide the required details about the condition or disability you are applying for. This includes the specific diagnosis, the date of the examination, and whether it is a new claim or a request for a reevaluation.
05
In the "Purpose of Examination" section, explain the reason for the examination. Indicate whether it is for initial evaluation, reevaluation, or special purposes.
06
If you are claiming secondary disabilities, provide the necessary information in the "Secondary Service Connection Claimed" section. Include the specific condition, symptoms, and any additional relevant details.
07
If you had any prior or concurrent examinations, list them in the next section, "Prior Examinations." Include the dates of the previous examinations and any additional important information related to them.
08
Finally, sign and date the form in the designated area, acknowledging the accuracy and completeness of the information provided.

Who needs VA Form 21-0960G-2:

01
Veterans who are applying for disability benefits from the Department of Veterans Affairs (VA) related to a specific medical condition or disability.
02
Individuals who require a medical provider to conduct an examination and provide a medical opinion regarding their condition or disability.
03
Veterans who have previously undergone an examination but need a reevaluation or have developed secondary disabilities that require additional assessment.
04
Applicants seeking to establish a service-connected condition or disability to qualify for benefits and compensation from the VA.
05
Anyone who is currently receiving VA benefits but requires a special examination for a specific purpose, such as a follow-up evaluation or determination of increased impairment or disability ratings.
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VA Form 21-0960G-2 is the Disability Benefits Questionnaire for Initial Post-Traumatic Stress Disorder (PTSD) Examination.
Veterans who are applying for disability benefits related to Post-Traumatic Stress Disorder (PTSD) are required to file VA Form 21-0960G-2.
VA Form 21-0960G-2 should be filled out by a qualified healthcare provider during the initial PTSD examination of the veteran.
The purpose of VA Form 21-0960G-2 is to provide detailed information about the veteran's PTSD symptoms and how they impact their daily life, in order to assist in the evaluation of disability benefits.
VA Form 21-0960G-2 requires information about the veteran's current symptoms, how long they have been experiencing them, any triggers, and the impact on their daily functioning.
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