Public Facing Disability Benefits Questionnaires (DBQs)

If you complete a Disability Benefits Questionnaire (DBQ) the processing time for your VA claim may decrease. Your private physician fills out a form explaining your diagnosis and the severity of your condition.

The VA will not pay for or reimburse you for any expenses associated with getting a DBQ form filled out by a private physician. Generally, VA physicians will not fill a DBQ or make a medical statement in support of a VA claim. As per VHA Directive 1134(1) D VA providers can if they choose to. Here is the directive: VHA Directive 1134(1)d .

Ask your physician if they are willing to fill out the DBQ form before you schedule your appointment. You will also need to submit an Authorization and Consent to Release form (VA 21-4142) to the VA for your DBQ. The form must be completed, printed and signed or the VA will not accept it.

Information about how the VA evaluates disabilities and what the VA considers a disability for rating purposes can be found in Title 38 of the United States Code and Title 38 of the Code of federal Regulations.

There is a DBQ available for most conditions ratable by the VA, but not all. You will need to have a VA exam for certain conditions.

DBQs were developed as a specific means to collect the necessary medical information required in the processing of Veterans disability claims.  DBQs provide Veterans with a way to submit medical evidence from their health care provider to support their claims for disability benefits. Veterans can have their health care providers fill out and submit to VA any of the DBQs listed below that are appropriate for their claimed conditions.

It is important to note the Department of Veterans Affairs (VA) will not pay or reimburse any expenses or costs incurred in the process of completing and/or submitting DBQs completed by the Veteran’s healthcare provider.  In most instances a Veteran is entitled to a no cost disability examination to be furnished by VA.  In some instances, VA may determine an additional disability examination is still required to complete the claim for disability benefits. When a VA examination is scheduled, the claimant must cooperate by reporting for the examination.

It is intended that the DBQs will be completed by the Veteran's health care provider. All clinician information blocks at the bottom of the DBQs must be completed and the form signed and dated by the clinician completing the DBQ. VA reserves the right to confirm the authenticity of ALL DBQs completed by health care providers. Information submitted is subject to verification through computer matching programs with other agencies or any other means deemed appropriate by VA.

We make no claims as to how helpful these may be in the outcome of a veteran’s case nor are we providing advice; we are simply providing access to this resource to allow veterans the greatest choice and control over the VA claims process.

Separation Health Assessment DBQ

If filing through a Benefits Delivery at Discharge or Integrated Disability Evaluation System, you must complete the Separation Health Assessment DBQ - Part A.

All clinician information blocks at the bottom of the forms must be completed. Also, the clinician filling out the form must sign and date it. We reserve the right to confirm the authenticity of ALL DBQs. Information is subject to verification through computer matching programs with other agencies or any other means deemed appropriate.

• Separation Health Assessment DBQ - Part A

• Guidance for Separation Health Assessment DBQ - Part A

Cardiovascular

• Artery and Vein Conditions

• Heart Conditions

• Hypertension

Dental & Oral

• Oral and Dental

Dermatological

• Scars

• Skin Diseases

Endocrinological

• Diabetes Mellitus

• Endocrine (Other than Thyroid, Parathyroid or Diabetes Mellitus)

• Thyroid and Parathyroid

ENT

• Ear (including Vestibular and Infectious)

• Loss of Sense of Smell and or Taste

• Sinusitis, Rhinitis and Other Conditions of the Nose, Throat, Larynx and Pharynx

Exams

• Prisoner of War DBQ

• Separation Health Assessment DBQ

• Persin Gulf - Afghanistan DBQ

• General Medical Compensation

• Gulf War General Medical Including Burn Pits

Gastrointestinal

• Esophageal Disorders

• Gallbladder

• Hernias (Including Abdominal, Inguinal and Femoral Hernias)

• Intestinal

• Liver Conditions

• Pancreas

• Peritoneal Adhesions

• Rectum & Anus

• Stomach and Duodenum

Genitourinary

• Kidney Conditions

• Male Reproductive Organ Conditions (Including Prostate Cancer)

• Urinary Tract Conditions

Gynecological

• Breast

• Gynecological Conditions

Gulf War General Exam (Not a DBQ)

    DMA Gulf War General Medical Examination

Hematologic & Lymphatic

• Hematologic and Lymphatic Conditions, Including Leukemia

Infectious Diseases

• HIV-Related Illnesses

• Infectious Diseases (other than HIV-related illness chronic fatigue syndrome and tuberculosis)

• Persian Gulf/Afghanistan Infectious Diseases

• Tuberculosis

Musculoskeletal

• Amputations

• Ankle

• Back (Thoracolumbar Spine)

• Bones and Other Skeletal Conditions

• Elbow & Forearm

• Foot Conditions Including Flatfoot (Pes Planus)

• Hand and Finger

• Hip and Thigh

• Knee and Lower Leg

• Muscle Injuries

• Neck (Cervical Spine)

• Osteomyelitis

• Shoulder and/or Arm

• Temporomandibular Disorders

• Wrist

Neurological

• ALS (Lou Gehrig's Disease)

• Central Nervous System and Neuromuscular Diseases

• Cranial Nerve Conditions

• Diabetic Peripheral Neuropathy

• Fibromyalgia

• Headaches (including Migraines)

• Multiple Sclerosis (MS)

• Narcolepsy

• Parkinson's Disease

• Peripheral Nerves

• Seizure Disorders (Epilepsy)

Nutrition

• Nutritional Deficiencies

Ophthalmological

• Eye Conditions

Psychological

• Eating Disorders

• Mental Disorders

• PTSD Initial INTERNAL 2018

• PTSD Review

Respiratory

• Respiratory Conditions (other than tuberculosis and sleep apnea)

• Sleep Apnea

Rheumatological

• Arthritis

• Chronic Fatigue Syndrome

• Systemic Lupus Erythematosus (SLE) and other Autoimmune Diseases

Spina Bifida (natural child of a Veteran exposed to herbicides)

• Spina Bifida

Aid and Attendance or Housebound

• VA Form 21-2680