Va form 21 0960a 1 2025

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, indicate whether the veteran has ischemic heart disease (IHD) by selecting 'Yes' or 'No.' If 'Yes,' provide up to three diagnoses along with their ICD codes and dates of diagnosis.
4. Move to Section II and answer whether continuous medication is part of the treatment plan. List any prescribed medications related to IHD.
5. In Section III, confirm if the veteran has congestive heart failure (CHF) and provide details about its chronicity and any episodes in the past year.
6. Proceed to Section IV, where you will note if a diagnostic exercise test was conducted and provide relevant METs levels based on symptoms experienced during physical activity.
7. Complete Section V by indicating any evidence of cardiac hypertrophy or dilatation, along with dates of diagnostic tests performed.
8. In Section VI, describe how IHD impacts the veteran's ability to work, if applicable. Finally, ensure that a physician certifies and signs in Section VII before submission.

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