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Evidence checklist

Atrial Fibrillation

DC 701038 CFR § 4.104Cardiovascular

Evidence strength

Mark what you already have below and your evidence strength appears here.

Target
Saved locally
01

Specialist opinion

Highest value0 of 3 collected
ECG or Holter monitor documenting episodesCritical

Electrocardiogram or 24-48 hour Holter monitor recording confirming atrial fibrillation episodes, including paroxysmal, persistent, or permanent AF.

Private provider · independent opinion
Nexus opinion linking atrial fibrillation to service ("at least as likely as not")Critical

A medical opinion connecting your atrial fibrillation to service-connected hypertension, coronary artery disease, thyroid disease, or other service-related cause.

Private provider · independent opinion
Echocardiogram

Echocardiography documenting chamber size, ejection fraction, and any structural abnormalities contributing to or resulting from atrial fibrillation.

Private provider · independent opinion
02

Treatment records

0 of 1 collected
Anticoagulation medication records

Prescription records for blood thinners (warfarin, DOACs), INR monitoring records, and documentation of bleeding complications.

VA or private records · written request
03

Lay statements

0 of 3 collected
Episode frequency log

A personal or medical log documenting the frequency, duration, and symptoms of atrial fibrillation episodes including palpitations, dizziness, and fatigue.

You or a witness · VA Form 21-4138 or 21-10210How to get this →
Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

You or a witness · VA Form 21-4138 or 21-10210How to get this →
Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

You or a witness · VA Form 21-4138 or 21-10210How to get this →
04

Benefits questionnaire

0 of 1 collected
Completed DBQ Heart ConditionsCritical

Standardized form capturing arrhythmia documentation, ejection fraction, METs capacity, and functional limitations.

Provider-completed · VA DBQ formHow to get this →
05

Service records

0 of 1 collected
Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.

NPRC / milConnect · SF-180

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