21 0960c 2026

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.

Here's how it works

01. Edit your va disability claim online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send disability claim via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out 21 0960c with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

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.

Start using our platform today for free to streamline your form completion process!

See more va disability claim versions

We've got more versions of the va disability claim form. Select the right va disability claim version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2016	4.2 Satisfied (34 Votes)
2012	4.9 Satisfied (45 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

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.