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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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VA Fast Letter 10-34.pdf


Veterans Benefits Administration

Washington, D.C. 20420

September 2, 2010

Director (00/21)

All VA Regional Offices and Centers

In Reply Refer To: 211

Fast Letter 10-34

SUBJ: Disability Benefits Questionnaires

As part of the Pittsburgh Regional Office's Innovation Initiative, a working group composed of representatives from VBA, VHA, Office of the General Counsel, the Board of Veterans' Appeals and the Pittsburgh Regional Office, was formed to develop streamlined Disability Benefits Questionnaires.

Formerly known as Worksheets, the streamlined Questionnaires are designed for use by both private and VA physicians in connection with applications for VA disability benefits. Each Questionnaire is derived directly from the disability rating criteria contained in the VA Schedule for Rating Disabilities.

The first three Questionnaires that the working group developed are attached. They pertain to the disabilities related to herbicide exposure that are part of the proposed Agent Orange regulation: Ischemic Heart Disease, Hairy Cell Leukemia and other B-cell Leukemias, and Parkinson's Disease.

The three attached Questionnaires have been approved by OMB and can be filled out by the Veteran's treating or examining physician (VA or private).

The Questionnaires have been sent for programming in VISTA. Notification will be provided once the questionnaire is available in VISTA.

For any questions e-mail VAVBAWAS/CO/21Q&A.


Thomas J. Murphy


Compensation and Pension Service


Ischemic Heart Disease Disability Benefits Questionnaire

Hairy Cell and Other B-cell Leukemias Disability Benefits Questionnaire

Parkinson's Disease Disability Benefits Questionnaire

NOTE TO USER: These forms are available online at VA.gov. Their numbers are:

21-0960A Ischemic Heart Disease Disability Benefits Questionnaire

21-0960B Hairy Cell and Other B-cell Leukemias Disability Benefits Questionnaire

21-0960C Parkinson's Disease Disability Benefits Questionnaire

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