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.

Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act of 2025

Requires Medical Disability Examination (MDE) contractors to provide completed DBQs in a PDF format. VA uses a standardized data exchange framework to simplify the electronic sharing of DBQs between approved users. This framework guarantees that MDE contractors, VA employees, and other stakeholders can seamlessly exchange information and evidence related to a Veteran’s claim.

The new DBQ Portal Implementation Plan, provided under Section 306(b) of the Elizabeth Dole Act, describes VA’s proposed system and process updates to allow non-VA healthcare providers to submit medical documents to VA in a digital format. The plan is in the early stages of implementation and may be subject to revisions.

Download the DBQ portal plan

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.

• Separation Health Assessment DBQ - Part A
• Guidance for 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

• 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

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

• Breast
• Gynecological Conditions

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 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

• 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 

return to top