21 0960c 2026

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The document is a Fibromyalgia Disability Benefits Questionnaire used by the U.S. Department of Veterans Affairs (VA) to evaluate veterans applying for disability benefits related to fibromyalgia. It includes sections for diagnosis, medical history, findings, symptoms, functional impact, and physician certification. The form emphasizes that the VA will not reimburse any costs incurred in completing it and outlines the importance of accurate information for processing claims.

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Click ‘Get Form’ to open the 21 0960c in the editor.
Begin by entering the patient/veteran's social security number and name at the top of the form. This information is crucial for identification.
In Section I, indicate whether the veteran has been diagnosed with fibromyalgia 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, where you will indicate which medical records were reviewed in preparation for this report. Select from options like C-FILE or provide a description of other records.
In Section III, describe the veteran's medical history related to fibromyalgia, including medication requirements and ongoing treatments. Be thorough in your descriptions.
Continue through Sections IV to IX, ensuring you check all relevant symptoms, findings, and impacts on work ability. Complete physician certification at the end.

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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.

Is VA duty to assist error a good thing?

If the reviewer finds that we didnt help you get all the evidence you needed for your claim, this is called a duty-to-assist error. To fix this error, well close the review and open a new claim to gather the missing evidence. Well also send you a letter to tell you the steps well take to fix the error.

How long is the VA taking to correct an error?

How long does it take VA to make a decision? Our goal for completing Higher-Level Reviews is 125 days. A review may take longer if we need to get records or schedule a new exam to correct an error.

Is VA correcting an error a good thing?

Keep in mind that while identifying an error can sound concerning, its an error made by the VA, not the veteran, so having the VA identify and fix their mistake is typically a positive development.

How much does the widow of a 100% disabled veteran receive?

Benefits for the Surviving Spouse of a 100% Disabled Veteran If your spouse dies with a 100% disability rating, you may be entitled to Dependency and Indemnity Compensation (DIC). For 2024, the base rate of compensation for a surviving spouse is $1,612.75/month.

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