VA Form 21-0960N-3 Loss of Sense of Smell and or Taste - Disability Benefits Questionnaire - vba va 2025

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The ADA defines disability as a physical or mental impairment that substantially limits one or more major life activities of such individual. As your senses (smelling and taste) are major life activities, this would qualify anosmia as a disability.
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
Relate your the symptoms of your condition to the DBQ for your condition. Dont exaggerate. Tell how stated condition effects you, give examples. Make sure your verbiage is VA friendly. Easy stuff. There is a formula to it, as there is with all things VA.
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.
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.
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Under Diagnostic Code 6275, complete loss of the sense of smell warrants a 10 percent disability rating. 38 C.F.R.