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- Click ‘Get Form’ to open the vba 21 0960j 1 in the editor.
- Begin by entering the patient's name and Social Security number in the designated fields at the top of the form.
- In Section I, Diagnosis, indicate whether the veteran has been diagnosed with a kidney condition by selecting 'Yes' or 'No'. If 'Yes', complete Item 1B by checking all applicable diagnoses and providing ICD codes and dates of diagnosis.
- Proceed to Section II, Medical History. Provide a brief summary of the veteran's kidney condition history and list any continuous medications being taken for treatment.
- Continue through Sections III to XII, ensuring that you answer all questions accurately. Use checkboxes where applicable and provide detailed information as required.
- Once completed, review all entries for accuracy before saving your document. You can easily share or print it directly from our platform.
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Related links
This document is the publicly released Kidney Conditions (Nephrology) Disability Benefits Questionnaire.
The VA form for erectile dysfunction refers primarily to the Disability Benefits Questionnaire (DBQ) labeled VA Form 21-0960J-2. Doctors or examiners use itRead more