Get and Sign Va Form 21 0960j 2 2018-2022

Name: Reproductive Conditions Benefits - Fill Out and Sign Printable PDF Template | signNow
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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. VA reserves the right to confirm the authenticity of ALL DBQs completed by private health care providers. SECTION I - DIAGNOSIS 1A. DOES THE VETERAN NOW HAVE OR HAS HE EVER BEEN DIAGNOSED WITH ANY CONDITIONS OF THE MALE REPRODUCTIVE SYSTEM? YES NO (If "Yes," complete Item...

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