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VA Form 21-0960G-7 STOMACH AND DUODENAL CONDITIONS (NOT INCLUDING GERD OR ESOPHAGEAL DISORDERS) DISA 2026
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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. This information is crucial for identification purposes.
- In Section I, indicate whether the veteran currently has or has ever had any stomach or duodenum conditions by selecting 'Yes' or 'No'. If 'Yes', check all applicable conditions listed in Item 1B and provide corresponding ICD codes and dates of diagnosis.
- Proceed to Section II to summarize the medical history related to the veteran's stomach or duodenum conditions. Include details about any continuous medications being taken.
- In Section III, check any signs or symptoms experienced by the veteran due to their condition. Be sure to specify frequency and duration where applicable.
- Continue through Sections IV to IX, providing detailed responses regarding incapacitating episodes, other conditions, diagnostic testing results, functional impact, and any remarks necessary.
- Finally, ensure that a physician completes Section X with their signature and contact information before submitting the form.
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