Va Form 21-0960m-7 - Hand And Finger Conditions Disability Benefits Questionnaire Page 5

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SECTION IX - OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS AND/OR SYMPTOMS

(surgical or otherwise)

9A. DOES THE VETERAN HAVE ANY SCARS

RELATED TO ANY CONDITIONS OR TO THE TREATMENT OF ANY CONDITIONS LISTED

IN SECTION I, DIAGNOSIS?

YES

(If "Yes," are any of the scars painful and/or unstable, or is the total area of all related scars greater than or equal to 39 square cm (6 square inches?)):

YES

(If "Yes," ALSO complete VA Form 21-0960F-1, Scars/Disfigurement Disability Benefits Questionnaire)

9B. DOES THE VETERAN HAVE ANY OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS AND/OR SYMPTOMS RELATED TO ANY

CONDITIONS LISTED IN SECTION I, DIAGNOSIS?

(If "Yes," describe - brief summary):

YES

SECTION X - ASSISTIVE DEVICES AND REMAINING FUNCTION OF THE EXTREMITIES

10A. DOES THE VETERAN USE ANY ASSISTIVE DEVICES?

YES

(If "Yes," identify assistive device(s) used (check all that apply and indicate frequency):

BRACE(S)

Frequency of use:

Occasional

Regular

Constant

OTHER:

Frequency of use:

Occasional

Regular

Constant

10B. IF THE VETERAN USES ANY ASSISTIVE DEVICES, SPECIFY THE CONDITION AND IDENTIFY THE ASSISTIVE DEVICE USED FOR EACH CONDTION:

SECTION XI - REMAINING EFFECTIVE FUNCTION OF THE EXTREMITIES

11. DUE TO THE VETERAN'S HAND, FINGER OR THUMB CONDITIONS, IS THERE FUNCTIONAL IMPAIRMENT OF AN EXTREMITY SUCH THAT NO EFFECTIVE

(Functions of the upper

FUNCTION REMAINS OTHER THAN THAT WHICH WOULD BE EQUALLY WELL SERVED BY AN AMPUTATION WITH PROSTHESIS?

extremity include grasping, manipulation, etc.)

YES, functioning is so diminished that amputation with prosthesis would equally serve the veteran

(If "Yes," indicate extremities for which this applies):

Right upper

Left upper

(For each checked extremity, identify the condition causing loss of function, describe loss of effective function and provide specific examples - brief summary):

SECTION XII - DIAGNOSTIC TESTING

NOTE - The diagnosis of arthritis must be confirmed by imaging studies. Once arthritis has been documented, no further imaging studies are indicated, even if arthritis

has worsened.

12A. HAVE IMAGING STUDIES OF THE HANDS BEEN PERFORMED AND ARE THE RESULTS AVAILABLE?

YES

(If "Yes," are there abnormal findings?)

YES

(If "Yes," indicate findings):

Degenerative or traumatic arthritis

Right

Left

Both

Hand:

(Is degenerative or traumatic arthritis documented in multiple joints of the same hand, including thumb and fingers?)