VA Form 21-0960A-3 - vba va 2026

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  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 identifying the veteran's records.
  3. In Section I, provide details regarding any diagnoses of hypertension or isolated systolic hypertension. Indicate 'Yes' or 'No' and include relevant ICD codes and dates of diagnosis.
  4. Move to Section II to describe the medical history of the veteran's hypertension condition. Include treatment plans and confirm if initial diagnoses were based on multiple blood pressure readings.
  5. In Section III, answer questions about any related physical findings or complications. If applicable, complete additional forms for scars or other conditions.
  6. Section IV requires you to assess how hypertension impacts the veteran's ability to work. Provide specific examples if applicable.
  7. Finally, ensure that a physician certifies and signs the form in Section VI, providing their contact information as required.

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Any doctor, including your primary care physician, can fill out a DBQ. If it is an area of specialty, such as cancer or mental health, the DBQ should be completed by a physician who is qualified in that area.
DBQs help collect necessary medical information to process your disability claims. You can use these forms to submit medical evidence from your health care providers. This information helps to support your claims for disability benefits.
Doctors Note, or Medical NexusIt can be helpful to have a doctor submit a letter stating that there is a causal relationship between your sleep apnea and your hypertension. Your doctor should state that they believe your hypertension is at least as likely as not caused by your sleep apnea.
The Disability Benefit Questionnaire (DBQ) form 21-0960C-8 is a vital tool for veterans to document the severity of their migraines, providing structured evidence to support the claim. Properly filled out, it can be an important pillar of your claim.
DBQs provide Veterans with a way to submit medical evidence from their private health care provider to support claims for disability benefits. A VA Claims Processor determines whether a compensation pension (CP) exam is needed.

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The Veterans Benefits Administration (VBA) helps veterans receive benefits, such as educational and financial resources.
NOTE 2: For VA purposes, the INITIAL diagnosis of hypertension or isolated systolic hypertension must be confirmed by readings taken 2 or more times on at least 3 different days. Blood pressure results may be obtained from existing medical records or through scheduled visits for blood pressure measurements.

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