Va form 21 0960n 1 2026

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The document is a Disability Benefits Questionnaire (DBQ) for ear conditions, including vestibular and infectious conditions, used by the U.S. Department of Veterans Affairs (VA) to assess veterans' eligibility for disability benefits. It includes sections for diagnosis, medical history, symptoms, surgical treatment, physical examination findings, diagnostic testing, functional impact, and physician certification. The form emphasizes that the VA will not reimburse any costs incurred in completing it and contains privacy notices regarding the handling of personal information.

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Click ‘Get Form’ to open it in the editor.
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.
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.
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.
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.
Finally, complete Section XII with the physician's certification and signature. Ensure all fields are filled accurately before submitting.

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Versions	Form popularity	Fillable & printable
2022	4.1 Satisfied (50 Votes)
2016	5 Satisfied (21 Votes)
2012	4.3 Satisfied (28 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What are the most common secondary claims to tinnitus?

What Conditions are Secondary to Tinnitus? Hearing Loss Often associated with tinnitus. Traumatic Brain Injury (TBI) TBIs can cause or worsen tinnitus. Mental Health Conditions Anxiety, depression, and PTSD are frequently associated with tinnitus.

What syndromes are associated with tinnitus?

Diabetes, migraines, thyroid disorders, anemia, and certain autoimmune disorders such as lupus and multiple sclerosis are among the chronic conditions that have been linked to tinnitus.

What are the top 5 conditions secondary to tinnitus?

Although tinnitus can improve with treatment, there is no known cure for the condition. Hearing Loss. Hearing loss and tinnitus are often interconnected, particularly for veterans who have been exposed to loud noises during military service. Depression. Anxiety. Insomnia. Concentration. Social Isolation. Migraines. Stress.

What are secondary issues related to tinnitus?

Tinnitus can lead to stress, anxiety, depression, insomnia, and social inactivity. If you have any of the secondary conditions related to tinnitus, you can apply for VA disability.

What other conditions can tinnitus cause?

If you have tinnitus, you may also experience: Fatigue. Stress. Sleep problems. Trouble concentrating. Memory problems. Depression. Anxiety and irritability. Headaches.

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What is VA form 21 10210 used for?

When to use this form. Use VA Form 21-10210 to submit a formal statement to support your VA claimor the claim of another Veteran or eligible family member. People also sometimes call this statement a buddy statement.

What are the new VA rules for tinnitus?

As a result of this new change coming, tinnitus will only be rated as a symptom of hearing loss. If your hearing loss already qualifies for a 10% rating or higher, you wont receive any additional compensation for your tinnitus. What This Means for You: If you already have a tinnitus rating: Your benefits are safe.

Va form 21 0960n 1 2026

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