Va form 21 0960n 1 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the name of the patient/veteran and their Social Security number at the top of the form. This information is crucial for identification purposes.
3. In Section I, Diagnosis, indicate whether the veteran has been diagnosed with an ear or peripheral vestibular condition 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, Medical History. Provide a brief summary of the veteran's ear conditions and specify if continuous medication is part of their treatment plan.
5. Continue through Sections III to VIII, ensuring you check all relevant symptoms, findings, and treatments. Be thorough in your descriptions to support the claim effectively.
6. Finally, complete Section XII with the physician's certification and signature. Ensure all fields are filled accurately before submitting.

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