Va Form 21-0960j-2 - Male Reproductive Organ Conditions Disability Benefits Questionnaire Page 5

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SECTION IX - TUMORS AND NEOPLASMS

9A. DOES THE VETERAN HAVE A BENIGN OR MALIGNANT NEOPLASM OR METASTASES RELATED TO ANY OF THE DIAGNOSES IN SECTION I, DIAGNOSIS?

(If yes, complete Items 9B thru 9E)

YES

9B. IS THE NEOPLASM:

BENIGN

MALIGNANT

9C. HAS THE VETERAN COMPLETED TREATMENT OR IS THE VETERAN CURRENTLY UNDERGOING TREATMENT FOR A BENIGN OR MALIGNANT NEOPLASM

OR METASTASES?

YES

NO; WATCHFUL WAITING

(If yes, indicate type of treatment the veteran is currently undergoing or has completed (check all that apply)):

Treatment completed; currently in watchful waiting status

Surgery

If checked, describe:

Date(s) of surgery:

Radiation therapy

Date of most recent treatment:

Date of completion of treatment or anticipated date of completion:

Antineoplastic chemotherapy

Date of most recent treatment:

Date of completion of treatment or anticipated date of completion:

Other therapeutic procedure

If checked, describe procedure:

Date of most recent procedure:

Other therapeutic treatment

If checked, describe treatment:

Date of completion of treatment or anticipated date of completion:

9D. DOES THE VETERAN CURRENTLY HAVE ANY RESIDUAL CONDITIONS OR COMPLICATIONS DUE TO THE NEOPLASM (INCLUDING METASTASES) OR ITS

TREATMENT, OTHER THAN THOSE ALREADY DOCUMENTED IN THE REPORT ABOVE?

(If yes, list residual conditions and complications (brief summary)):

YES

9E. IF THERE ARE ADDITIONAL BENIGN OR MALIGNANT NEOPLASMS OR METASTASES RELATED TO ANY OF THE DIAGNOSES IN SECTION I, DIAGNOSIS,

DESCRIBE USING THE ABOVE FORMAT:

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

10A. DOES THE VETERAN HAVE ANY SCARS (SURGICAL OR OTHERWISE) RELATED TO ANY CONDITION 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.)

10B. DOES THE VETERAN HAVE ANY OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS OR SYMPTOMS?

(If yes, describe (brief summary)):

YES

SECTION XI - DIAGNOSTIC TESTING

NOTE: If imaging studies, diagnostic procedures or laboratory testing has been performed and reflects the veteran's current condition, provide most recent results; no

further studies or testing are required for this examination. When appropriate, provide most recent results. No specific studies are required for this examination.

11A. HAS A TESTICULAR BIOPSY BEEN PERFORMED?

YES

Date of biopsy:

Results:

Spermatozoa present

Other, describe:

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VA FORM 21-0960J-2, OCT 2012