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
- Diabetes Mellitus
- Endocrine (Other than Thyroid, Parathyroid or Diabetes Mellitus)
- Thyroid and Parathyroid
Ear, Nose, Throat
- 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
Gastrointestinal
- Esophageal Disorders
- Gallbladder
- Hernias (Including Abdominal, Inguinal and Femoral Hernias)
- Intestinal Conditions
- Liver Conditions
- Pancreas
- Peritoneal Adhesions
- Rectum & Anus
- Stomach and Duodenum
Genitourinary
- Kidney Conditions
- Male Reproductive Organ Conditions (Including Prostate Cancer)
- Urinary Tract Conditions
Gynecological
Hematologic & Lymphatic
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
Ophthalmological
Psychological
Respiratory
Rheumatological
Spina Bifida (natural child of a Veteran exposed to herbicides)
Aid and Attendance or Housebound
- Please search the Find a VA Form webpage for VA Form 21-2680.
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