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Va ischemic heart disease worksheet pdf

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

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The document is a Disability Benefits Questionnaire (DBQ) for heart conditions, including ischemic and non-ischemic heart disease, arrhythmias, valvular disease, and cardiac surgery. It is intended for veterans applying for disability benefits from the U.S. Department of Veterans Affairs (VA). The form collects detailed medical history, diagnoses, treatment procedures, and physical examination findings related to the veteran's heart conditions. It emphasizes that the VA will not reimburse any costs incurred in completing the form and includes privacy notices regarding the handling of personal information.

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How to use or fill out VA Form 21-0960A-4 Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) Disability Benefit

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Click ‘Get Form’ to open it in the editor.
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.
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.
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.
Finally, complete Section XVII - Physician's Certification. The physician must sign and provide their contact information before submitting the form.

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

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Versions	Form popularity	Fillable & printable
2014	4 Satisfied (22 Votes)
2012	4 Satisfied (37 Votes)
2011	4.3 Satisfied (35 Votes)

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What heart conditions automatically qualify you for disability?

Chronic heart failure which typically leads to other conditions, such as congestive heart failure. Aneurysms in the aorta or other major branches, or more simply, swelling of the hearts major arteries. Peripheral arterial disease, or damaged functions of the outer arteries.

Does an irregular heartbeat qualify for disability?

To qualify for SSDI, you must meet all of the following criteria: The arrhythmias must cause fainting or loss of consciousness (syncope) or cause an altered consciousness (near syncope) on at least three different occasions in the past 12 months; AND. An EKG must verify that the arrhythmias are related to fainting; AND.

Does heart arrhythmia qualify for disability?

Heart Arrhythmia Due to Agent Orange Exposure Heart arrhythmia might also result from other sources of toxic exposure, like burn pits. The Promise to Address Comprehensive Toxics Act, commonly known as the PACT Act, expanded benefits to veterans exposed to burn pits, Agent Orange, and other toxins.

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How much is VA disability for heart disease?

Depending on the nature and severity of a heart disease condition, you can receive a VA disability rating of 10%, 30%, 60%, or 100%. If you want to obtain a VA rating for heart disease, call Stone Rose Law at (480) 498-8998 or use our contact form.

Can you get VA disability for heart arrhythmia?

Even though a veterans heart arrhythmia is not a presumptive condition, a veteran can still claim it as a VA disability through direct service connection or secondary service connection if they can provide evidence linking their condition to their military service or to another service-connected condition.

Is arrhythmias a VA disability?

The Department of Veterans Affairs (VA) assigns disability ratings for arrhythmia at four levels: 10%, 30%, 60%, or 100%. These ratings are determined based on how severe the condition is, how long it lasts, and how often symptoms occur.

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

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How to use or fill out VA Form 21-0960A-4 Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) Disability Benefit

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Got questions?

Can I draw my eSignature to sign my VA Form 21-0960A-4 Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) Disability Benefit?

Can I edit VA Form 21-0960A-4 Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) Disability Benefit on my phone?

What heart conditions automatically qualify you for disability?

Does an irregular heartbeat qualify for disability?

Does heart arrhythmia qualify for disability?

Security and compliance

People also ask

How much is VA disability for heart disease?

Can you get VA disability for heart arrhythmia?

Is arrhythmias a VA disability?

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

Here's how it works

How to use or fill out VA Form 21-0960A-4 Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) Disability Benefit

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

Complete this form in 5 minutes or less

Got questions?

Can I draw my eSignature to sign my VA Form 21-0960A-4 Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) Disability Benefit?

Can I edit VA Form 21-0960A-4 Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) Disability Benefit on my phone?

What heart conditions automatically qualify you for disability?

Does an irregular heartbeat qualify for disability?

Does heart arrhythmia qualify for disability?

Related Searches

Security and compliance

People also ask

How much is VA disability for heart disease?

Can you get VA disability for heart arrhythmia?

Is arrhythmias a VA disability?

Related links

Try more PDF tools