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VA Form 21-0960P-3 - Veterans Benefits Administration - US - vba va

VA Form 21-0960P-3 - Veterans Benefits Administration - US - vba va 2025

VA Form 21-0960P-3 - Veterans Benefits Administration - US - vba va Preview on Page 1

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The document is a Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire used by the U.S. Department of Veterans Affairs (VA) to evaluate veterans applying for disability benefits related to PTSD. It outlines the process for healthcare providers to assess and report on the veteran's mental health status, including diagnostic criteria, symptoms, and levels of occupational and social impairment. The form emphasizes that it is not for treatment purposes and includes important privacy and respondent burden information.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the patient/veteran's name and social security number in the designated fields at the top of the form.
In Section I, answer whether the veteran has been diagnosed with PTSD. If 'Yes', proceed to complete the questionnaire.
Move to Section II and list current diagnoses, including ICD codes and axis categories for each diagnosis. Ensure all relevant comments are included.
Continue through Sections III to IX, carefully checking boxes and providing detailed information as required about symptoms, occupational impairment, and any other relevant history.
Finally, ensure that a psychiatrist or psychologist certifies and signs the form in Section XI before submitting it.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (35 Votes)
2015	4.3 Satisfied (179 Votes)
2012	4.2 Satisfied (61 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.

How long is a VA form 21-4142 good for?

The VA Form 21-4142 is valid for 12 months from the date signed. It is permissible to authorize release of, and disclose, information created after the consent is signed.

What is the difference between VA Form 21 4142 and VA Form 21 4142a?

PTSD DBQ. During the CP PTSD exam, the proctor will administer a PTSD DBQ, or post-traumatic stress disorder disability benefits questionnaire. A DBQ is a publicly available form created by the VA for veterans to fill out that helps quantify the severity and service-connection of a disability.

What is the Dbq for PTSD CP exam?

Disability compensation benefits for Veterans The best way to file for disability compensation is to apply online at .va.gov/disability. Or, you can fax it to: (844) 531-7818 (inside the U.S.) (248) 524-4260 (outside the U.S.)

What does the VBA do for veterans?

Complete VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA) and VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA); submit completed forms with your claim and VA will attempt to obtain your records through our

What is VA form 21 22a used for?

When to use this form. Use VA Form 21-4192 if youre a Veteran and you need your most recent employer to send us information so you can apply for Individual Unemployability disability benefits. Your most recent employer must complete and submit this form.