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21-0960M-16. Wrist Conditions Disability Benefits Questionnaire - vba va 2025

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The document is a Wrist Conditions Disability Benefits Questionnaire (DBQ) used by the U.S. Department of Veterans Affairs (VA) to evaluate veterans applying for disability benefits related to wrist conditions. It includes sections for medical history, diagnosis, range of motion measurements, pain assessment, functional loss, muscle strength testing, and any surgical procedures. The form requires detailed information from both the veteran and the physician regarding the veteran's wrist condition and its impact on their daily functioning.

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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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What is the VA rating for ankylosis wrist?

Ratings for limitation of wrist motion are provided under Diagnostic Code 5215. A 10 percent rating is assigned where dorsiflexion is less than 15 degrees, or where palmar flexion is limited in line with the forearm. The 10 percent rating is the maximum rating available for limitation of wrist motion.

What is the VA disability rating for wrists?

50%: For unfavorable ankylosis, docHubly impairing functionality. 40%: Ankylosis in a position other than favorable but not as severe as unfavorable ankylosis. 30%: Favorable ankylosis, with the wrist fixed in a position of 20 to 30 degrees dorsiflexion, allowing some functional utility.

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