Va form 21 0960m 14 2025

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The document is a Disability Benefits Questionnaire (DBQ) for back (thoracolumbar spine) conditions, used by the U.S. Department of Veterans Affairs (VA) to evaluate veterans applying for disability benefits. It includes sections for diagnosis, medical history, range of motion measurements, functional loss, pain assessment, radiculopathy history, and other relevant findings. The form requires detailed information from both the veteran and their physician regarding the veteran's condition and its impact on their daily life and ability to work.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the veteran's name and Social Security number at the top of the form. This information is crucial for identification purposes.
In Section I, diagnose any thoracolumbar spine conditions. If applicable, provide detailed diagnoses along with ICD codes and dates of diagnosis.
Proceed to Section II to summarize the medical history related to the thoracolumbar spine condition, including any flare-ups that impact functionality.
For Section III, measure and record initial range of motion (ROM) using a goniometer. Ensure you document each measurement accurately.
Continue through Sections IV to XII, filling out details regarding functional loss, pain assessment, radiculopathy history, and any diagnostic testing results as required.
Finally, ensure that a physician certifies and signs the form in Section XIV before submission.

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How to get 100% VA disability for neck pain?

To qualify for VA benefits, veterans must prove their neck pain is connected to military service. This can be through direct service connection (injuries during service) or secondary service connection (neck pain caused by another service-related condition). Strong medical evidence is essential to support these claims.

How do I prove my back pain to the VA?

Proving a service connection for back pain is possible, but it takes more than reporting your symptoms. You need detailed medical records, documentation of your in-service injury, and a clear link between the two. If you struggle to get the VA to recognize your back pain as service-connected, VetLaw can help.

How to go from 60% to 100% VA disability?

To succeed, you should submit medical evidence as well as statements from family members, friends, or fellow veterans (buddy letters) who can attest to how your disability affects your daily life. These letters can help strengthen your claim by providing personal insights into your conditions impact.

What is a 40% rating for a lumbosacral strain?

40% rating will be assigned if you can bend your middle and lower back 30 degrees or less and your thoracolumbar spine is stuck in a neutral position.