Va forms 21 0960e1 2012-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name and Social Security number at the top of the form. This information is crucial for identification.
3. In Section I, select the veteran's condition from the provided options. If there are multiple diagnoses, list them accordingly along with their ICD codes and dates of diagnosis.
4. Move to Section II and check all applicable treatments. If regulation of activities is required, provide examples in the designated area.
5. Continue through Sections III to VI, checking boxes for complications and providing details on any impacts on work ability as necessary.
6. Complete Section VII with any additional remarks and ensure that a physician certifies and signs in Section VIII, including their contact information.

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