Disability benefits questionnaire by symptom
[DOC File]VA FORM 21-0960P-3, DEC 2010
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Please note that this questionnaire is for disability evaluation, not for treatment purposes. This evaluation should be based on DSM-5 diagnostic criteria. NOTE: If the Veteran experiences a mental health emergency during the interview, please terminate the interview …
[DOCX File]ASISTS V. 2.0 Release Notes Home
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Eating Disorders Disability Benefits Questionnaire . Name of patient/Veteran: _____SSN: Your patient is applying to the U. S. Department of Veterans Affairs (VA) for disability benefits. VA will consider the information you provide on this questionnaire as part of their evaluation in processing the Veteran’s claim.
[DOCX File]Purpose Home | Veterans Affairs
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6.1. Hearing Loss and Tinnitus Disability Benefits Questionnaire. Name of patient/Veteran: SSN: Your patient is applying to the U. S. Department of Veterans Affairs (VA) for disability benefits. VA . will consider the information you provide on this questionnaire as part of their evaluation in processing. the Veteran’s claim. NOTE:
[DOC File]MENTAL HEALTH IMPAIRMENT QUESTIONNIARE
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MENTAL HEALTH IMPAIRMENT QUESTIONNAIRE. UMass Medical School Disability Evaluation Services Program. 11 Midstate Drive, Auburn, MA 01501. Phone 800 888-3420 Fax 508 721-7292. To: Re: (Name of Patient) (Social Security No.) / / (Date of birth)
[DOCX File]Section D. Examination Reports - Veterans Affairs
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However, it may be considered on a secondary basis as a symptom of a SC disability, such as an anxiety disorder, TMJ dysfunction, or another disability for rating purposes. ... VA Form 21-0960L-2 Sleep Apnea Disability Benefits Questionnaire. m. TMJ Examination Report Review.
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