VA Form 21-0960H-1. HERNIAS (INCLUDING ABDOMINAL, INGUINAL AND FEMORAL HERNIAS) DISABILITY BENEFITS QUESTIONNAIRE - vba va 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name and Social Security number at the top of the form.
3. In Section I, indicate whether the veteran currently has or has ever had any hernia conditions by selecting 'Yes' or 'No'. If 'Yes', complete Item 1B by checking all applicable conditions and providing ICD codes and dates of diagnosis.
4. Proceed to Section II to indicate which medical records were reviewed in preparation for this report, such as C-FILE or other relevant documents.
5. In Section III, summarize the history of the veteran's hernia conditions and specify if continuous medication is required.
6. Complete Section IV by detailing surgical status, examination findings, and indications for support for each type of hernia listed.
7. Continue through Sections V to IX, providing any additional pertinent findings, diagnostic testing results, functional impact descriptions, and physician certification details.

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