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21-0960M-16. Wrist Conditions Disability Benefits Questionnaire - vba va 2026
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- Click ‘Get Form’ to open the 21-0960M-16 in the editor.
- Begin by entering the patient's name and Social Security number in the designated fields at the top of the form.
- In Section I, list any claimed wrist conditions and select associated diagnoses by checking the appropriate boxes.
- Proceed to Section II to describe the medical history of the wrist condition, including onset and flare-ups. Use text boxes for detailed descriptions.
- For Sections III and IV, measure and document range of motion (ROM) using a goniometer. Input measurements directly into the provided fields.
- Continue through Sections V to XIII, providing information on pain, functional loss, muscle strength testing, and any surgical procedures related to wrist conditions.
- Finally, review all entries for accuracy before submitting your completed form via our platform's submission feature.
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