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Compensation

 

Public Disability Benefits Questionnaires (DBQs)

DBQs help collect necessary medical information to process your disability claims. You can use these forms to submit medical evidence from your health care providers. This information helps to support your claims for disability benefits. Please have your health care provider fill out and submit the appropriate forms for your claimed conditions.

We do not pay or reimburse any expenses or costs incurred while completing and/or submitting DBQs.

In most instances, you're entitled to a no cost disability examination by us. In some instances, we may determine an additional disability examination is required to complete the claim. If an exam is scheduled, you must report for the examination.

If you are having any difficulty opening any file on this page, please right click on the link, choose "save link as," download to your computer, then open the file from your computer. After completing the document, print to PDF before electronically uploading.

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.

Cardiovascular

Dental & Oral

Dermatological

Endocrinological

Ear, Nose, Throat

Gastrointestinal

Genitourinary

Gynecological

Hematologic & Lymphatic

Infectious Diseases

Musculoskeletal

Neurological

Nutrition

Ophthalmological

Psychological

Respiratory

Rheumatological

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

Aid and Attendance or Housebound

The following DBQs are not available for public use. There are limitations outlined in federal regulations and/or specialized training needed to complete them.

  • Cold Injury Residuals
  • Former POW Protocol
  • General Medical – Compensation
  • General Medical – Pension
  • Gulf War General Medical Examination
  • Medical Opinion
  • Separation Health Assessment – Part B
  • Initial Post Traumatic Stress Disorder (PTSD)
  • Hearing Loss and Tinnitus
  • Initial Evaluation of Residuals of Traumatic Brain Injury
  • Review Evaluation of Residuals of Traumatic Brain Injury 
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