HomeVA Commonly Used FormsDisability Benefits Questionnaires (DBQ)Disability Benefits Questionnaire (DBQ) Forms

3.1. Disability Benefits Questionnaire (DBQ) Forms

Disability Benefits Questionnaires (DBQs) are medical examination forms used to obtain important information for evaluating disability compensation and/or pension claims.  VA physicians use DBQs when performing C&P exams for VA disability.

The purpose of a DBQ is to ensure that the physician performing the exam records all the information needed for VA to properly rate a disabled veteran’s conditions.

On 4/2/2020, VA sent a bulletin stating the Discontinuance of Publicly Available Disability Benefits Questionnaires (DBQs).  VA states they are "modernized"; whereby they are currently more than half-way through the process of updating all body systems in the VASRD (VA Schedule for Rating Disabilities), since the last update in 1945. As each body system is updated, so are the corresponding DBQs.

Citing abuse of the system, VA has removed DBQs from its public websites.  The VA says that DBQs will still be available to medical practitioners, who can use them in performing their official duties, but that they will no longer be available to the general public; as VA feel they have expanded its own capacity to conduct these examinations.

VA’s policy regarding accepting these forms directly from veterans’ providers has not changed. Therefore, we have provided links/pdf to a number of DBQs used by the VA, but no longer provided to the public.

Lastly, VA will continue to accept any evidence that veterans or their accredited representatives wish to submit in support of disability compensation or pension claims. 


Cardiovascular 

21-0960A-2 Artery and Vein Conditions (Vascular Diseases including Varicose Veins)
21-0960A-3 Hypertension
21-0960A-4 Heart Conditions (including IHD, Non-IHD, Arrhythmias, Valvular Disease and Cardiac Surgery)

Dental and Oral

21-0960M-15 Temporomandibular Joint (TMJ) Conditions
21-0960D-1 Oral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions)

Dermatological

21-0960F-1 Scars-Disfigurement
21-0960F-2 Skin Diseases

Ear, Nose, and Throat

21-0960N-1 Ear Conditions (including Vestibular and Infectious Conditions)
21-0960N-3 Loss of Sense of Smell and or Taste
21-0960N-4 Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx

Endocrinological

21-0960E-1 Diabetes Mellitus
21-0960E-2 Endocrine Diseases (other than Thyroid and Parathyroid or Diabetes Mellitus)
21-0960E-3 Thyroid and Parathyroid Conditions

Gastrointestinal

21-0960G-1 Esophageal Conditions (Including GERD, Hiatal Hernia and Other Esophageal Disorders)
21-0960G-2 Gallbladder and Pancreas Conditions
21-0960G-3 Intestinal Conditions (other than Surgical or Infectious) Including Irritable Bowel Syndrome, Crohn’s Disease, Ulcerative Colitis and Diverticulitis
21-0960G-4 Intestinal Surgery (Bowel Resection, Colostomy, Illiostomy)
21-0960G-5 Hepatitis, Cirrhosis, and other Liver Conditions
21-0960G-6 Peritoneal Adhesions
21-0960G-7 Stomach and Duodenal Conditions (not including GERD or Esophageal Disorders)
21-0960G-8 Infectious Intestinal Disorders (including Bacterial and Parasitic Infections)

Genitourinary

21-0960J-1 Kidney Conditions (Nephrology)
21-0960J-2 Male Reproductive Organ Conditions
21-0960J-3 Prostate Cancer
21-0960J-4 Urinary Tract (including Bladder and Urethra Conditions (excluding Male Reproductive System)

Gynecological

21-0960K-1 Breast Conditions and Disorders
21-0960K-2 Gynecological Conditions

Hematologic and Lymphatic

21-0960B-1 Hairy Cell and Other B-Cell Leukemias
21-0960B-2 Hematologic and Lymphatic Conditions, including Leukemia

Infectious Diseases

21-0960I-1 Persian-Gulf-and-Afghanistan-Infectious-Diseases

21-0960I-3 Infectious Diseases (other than HIV-Related Illness, Chronic Fatigue Syndrome, or Tuberculosis)

21-0960I-4 Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases
21-0960I-5 Nutritional Deficiencies
21-0960I-6 Tuberculosis

Musculoskeletal

21-0960M-1 Amputations
21-0960M-2 Ankle Conditions
21-0960M-3 Non-Degenerative Arthritis (including Inflammatory, Autoimmune, Crystalline and Infectious Arthritis) and Dysbaric Osteonecrosis
21-0960M-4 Elbow and Forearm Conditions
21-0960M-6 Foot Miscellaneous (other than Flatfoot and Pes Planus)
21-0960M-7 Hand and Finger Conditions
21-0960M-8 Hip and Thigh Conditions
21-0960M-9 Knee and Lower Leg Conditions
21-0960M-10 Muscle Injuries
21-0960M-11 Osteomyelitis
21-0960M-12 Shoulder and Arm Conditions
21-0960M-13 Neck (Cervical Spine) Conditions
21-0960M-14 Back (Thoracolumbar Spine) Conditions
21-0960M-16 Wrist Conditions

Neurological

21-0960C-1 Parkinson’s Disease
21-0960C-2 Amyotrophic Lateral Selerosis (Lou Gehrig’s Disease)
21-0960C-3 Cranial Nerve Conditions
21-0960C-4 Diabetic Sensory-Motor Peripheral Neuropathy
21-0960C-5 Central Nervous System and Neuromuscular Diseases (except TBI, ALS, PD, MS, Headaches, TMJ, Epilepsy, Narcolepsy, Peripheral Nerves, Sleep Apnea, Cranial Nerves, Fibromyalgia, and CFS)
21-0960C-6 Narcolepsy
21-0960C-7 Fibromyalgia
21-0960C-8 Headaches (Including Migraine Headaches)
21-0960C-9 Multiple Selerosis (MS)
21-0960C-10 Peripheral Nerve Conditions (Not Including Diabetic Sensory-Motor Peripheral Neuropathy)
21-0960C-11 Seizure Disorders

Ophthalmological

21-0960N-2 Eye Conditions

Psychological

21-0960P-1 Eating Disorders
21-0960P-2 Mental Disorders (other than PTSD)
21-0960P-3 Review Post Traumatic Stress Disorder (PTSD)

Respiratory

21-0960L-1 Respiratory Conditions (other than Tuberculosis and Sleep Apnea)
21-0960L-2 Sleep Apnea

Rheumatological

21-0960Q-1 Chronic Fatigue Syndrome

General Surgery

21-0960H-1 Hernias (including Abdominal, Inguinal, and Femoral Hernias)
21-0960H-2 Rectum and Anus Conditions (including Hemorrhoids)


Downloads

This page was: Helpful | Not Helpful