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OMB Approved No. 2900-0776 Respondent Burden: 30 minutes SHOULDER AND/OR ARM 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 21-0960m-12

How to Fill Out VA Form 21-0960M-12:

01

Start by providing your personal information.

1.1

Fill in your full name, social security number, and contact information.

1.2

Include your date of birth and gender.

02

Next, provide information about the condition you are seeking compensation for.

2.1

Write down the diagnosis of your medical condition and the date of diagnosis.

2.2

Indicate whether the condition is service-connected or aggravated by military service.

03

Specify your symptoms and their impact on your daily life.

3.1

Describe the symptoms you experience due to the medical condition.

3.2

Explain how these symptoms affect your ability to work, perform daily activities, or engage in physical or social activities.

04

Include details about any treatment you have received.

4.1

Provide information about the medical professionals you have seen.

4.2

List the medications, therapies, or surgeries you have undergone for the condition.

05

If applicable, mention any supporting documents or evidence.

5.1

Attach relevant medical records, test results, or opinions from healthcare providers.

5.2

Include any documents that prove the link between your condition and military service.

Who needs VA Form 21-0960M-12?

01

Veterans who are seeking disability compensation for a specific medical condition.

02

Individuals who want to establish a connection between their military service and a current medical issue.

03

Individuals who have been denied disability benefits and are submitting an appeal.

Please note that it is always advisable to consult with a Veterans Service Officer or an attorney who specializes in VA disability claims for assistance in accurately completing VA Form 21-0960M-12. These professionals can guide you through the process and ensure your application is complete and well-supported.

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What is va form 21-0960m-12?

Va form 21-0960m-12 is a Veteran's Application for Increased Compensation Based on Un-employability.

Who is required to file va form 21-0960m-12?

Veterans who are seeking increased compensation based on unemployability are required to file va form 21-0960m-12.

How to fill out va form 21-0960m-12?

Va form 21-0960m-12 should be filled out with accurate information about the veteran's employment history, medical conditions, and any relevant supporting documentation.

What is the purpose of va form 21-0960m-12?

The purpose of va form 21-0960m-12 is to apply for increased compensation based on unemployability due to service-connected disabilities.

What information must be reported on va form 21-0960m-12?

On va form 21-0960m-12, veterans must report detailed information about their employment history, medical conditions, and how those conditions prevent them from working.

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