VA Form 21-0960A-4 Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) Disability Benefit 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section I - Diagnosis. Indicate whether the veteran has been diagnosed with a heart condition by selecting 'Yes' or 'No'. If 'Yes', check all applicable conditions listed and provide the corresponding ICD codes and dates of diagnosis.
3. Move to Section II - Medical History. Provide a brief summary of the veteran's heart condition history, including any medications required for control. Ensure to list each medication along with its purpose.
4. Continue through Sections III to XV, answering questions regarding myocardial infarctions, congestive heart failure, arrhythmias, procedures, hospitalizations, and functional impacts. Fill in all relevant details as prompted.
5. Finally, complete Section XVII - Physician's Certification. The physician must sign and provide their contact information before submitting the form.

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