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VA Form 21-0960G-5. HEPATITIS, CIRRHOSIS AND OTHER LIVER CONDITIONS DISABILITY BENEFITS QUESTIONNAIRE - vba va 2025

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The document is a Disability Benefits Questionnaire (DBQ) for veterans applying for disability benefits related to liver conditions, including hepatitis, cirrhosis, and other liver diseases. It outlines the information required from both the veteran and their physician regarding diagnoses, medical history, symptoms, treatment, and functional impact on work. The form emphasizes that the Department of Veterans Affairs will not reimburse any costs incurred in completing it and includes privacy notices regarding the handling of personal information.

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How to use or fill out VA Form 21-0960G-5. HEPATITIS, CIRRHOSIS AND OTHER LIVER CONDITIONS DISABILITY BENEFITS QUESTIONNAIRE

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Click ‘Get Form’ to open it in the editor.
Begin by entering the patient's name and Social Security number at the top of the form.
In Section I, indicate whether the veteran has been diagnosed with a liver condition by selecting 'Yes' or 'No'. If 'Yes', complete Item 1B by checking all applicable conditions and providing ICD codes and dates of diagnosis.
Proceed to Section II to describe the medical history of the veteran's liver conditions, including any required medications.
In Section III, answer questions regarding hepatitis symptoms and risk factors. Be thorough in indicating frequency and severity where applicable.
Continue through Sections IV to VIII, providing detailed information about cirrhosis, liver transplant status, diagnostic testing results, and functional impact on work.
Finally, ensure that a physician certifies and signs the form in Section X before submission.

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What is the disability benefit questionnaire Dbq Form 21 0960C 8?

The Disability Benefit Questionnaire (DBQ) form 21-0960C-8 is a vital tool for veterans to document the severity of their migraines, providing structured evidence to support the claim. Properly filled out, it can be an important pillar of your claim.

How do I prove my VA disability for headaches?

Steps to File a VA Disability Claim for Migraines Medical records documenting your migraines and their severity. Service records or medical nexus letters linking your migraines to your military service. A migraine diary or other evidence showing how frequently your attacks occur.

What is a disability questionnaire?

DBQs help collect necessary medical information to process your disability claims. You can use these forms to submit medical evidence from your health care providers. This information helps to support your claims for disability benefits.

What is the VA rating for cirrhosis of the liver?

DBQs provide Veterans with a way to submit medical evidence from their private health care provider to support claims for disability benefits. A VA Claims Processor determines whether a compensation pension (CP) exam is needed.

Who typically completes a DBQ?

Any doctor, including your primary care physician, can fill out a DBQ. If it is an area of specialty, such as cancer or mental health, the DBQ should be completed by a physician who is qualified in that area.

VA Form 21-0960G-5. HEPATITIS, CIRRHOSIS AND OTHER LIVER CONDITIONS DISABILITY BENEFITS QUESTIONNAIRE - vba va 2025

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How to use or fill out VA Form 21-0960G-5. HEPATITIS, CIRRHOSIS AND OTHER LIVER CONDITIONS DISABILITY BENEFITS QUESTIONNAIRE