VA Form 21-0960N-4 - Veterans Benefits Administration - US ... - vba va 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name and Social Security number in the designated fields at the top of the form.
3. In Section I, indicate whether the veteran has been diagnosed with a sinus, nose, throat, larynx, or pharynx condition by selecting 'Yes' or 'No'. If 'Yes', complete Item 1B by checking all applicable conditions and providing ICD codes and dates of diagnosis.
4. Proceed to Section II to indicate any medical records reviewed. Specify if you have accessed the C-FILE or other records.
5. In Section III, describe the medical history related to the veteran's condition. Be thorough in detailing onset and course.
6. Continue through Sections IV to VI, checking applicable conditions and providing detailed responses as required. Ensure all relevant symptoms and impacts on work ability are documented.
7. Finally, complete Section VIII with the physician's certification and signature before submitting your form.

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