Ssection i - diagnosis. va €form dec 2014. 21-0960e-1. diabetes mellitus disability benefits questionnaire. name of patient/veteran. patient/veteran's social. 21B. DATE SIGNED PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been authorized under the Form 10-0094a: Medical Education Affiliation Agreement - School of Medicine: 11/19/2004: Form 10-0094b: Medical Education Affiliation Agreement - Osteopathic Medicine. Country Selector. United States Free Forms; Canada Free Forms; United Kingdom Free Forms; Australia Free Forms; Ask a Legal Question Here are two Freedom of Information Act (FOIA) letters. The first one I borrowed from a law firm for disabled veterans requesting copies of their disability claim. VAForm 21-0958. Search VA Forms. Notice of Disagreement (Fillable) File Type: PDF Issue Date: 02/23/2016 Revision Date: 9/2015 Total Pages: 4 VAForm 10-10EZ. Search VA Forms. Instructions For Completing Enrollment Application For Health Benefits Online Application Online Form) File Type: PDF | Online Form Prepare. Find out if you qualify. Check your eligibility. Gather the documents listed below that you’ll need to fill out the application for VA health care benefits.