Disability Benefits Questionnaires (DBQs)
Disability Benefits Questionnaires (“DBQs”) are standardized forms that are used by VA clinicians when performing disability examinations, or Compensation and Pension (“C&P”) exams. VA now uses more than 80 different DBQs with standardized language and check boxes to streamline the information intake process and ensure timely and accurate ratings decisions.
DBQs, first used in 2010, were originally developed to give veterans an improved method to submit private medical evidence to support their disability claims. As recently as April 2020, DBQs were available for download from the VA website for use by private physicians and therapists. On April 2, 2020, VA abruptly removed all “public-facing” DBQs from its website. (VA Announcement)
However, VA continues to use Disability Benefits Questionnaires (DBQs) during disability examinations.
**Even though VA has removed DBQs from its website, VA will still accept DBQs that are submitted with any claim for disability compensation benefits.
Cardiovascular
Form # | Form Name |
---|---|
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
Form # | Form Name |
---|---|
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
Form # | Form Name |
---|---|
21-0960F-1 | Scars/Disfigurement |
21-0960F-2 | Skin Diseases |
Ear, Nose and Throat
Form # | Form Name |
---|---|
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
Form # | Form Name |
---|---|
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
Genitourinary
Form # | Form Name |
---|---|
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
Form # | Form Name |
---|---|
21-0960K-1 | Breast Conditions and Disorders |
21-0960K-2 | Gynecological Conditions |
Hematologic and Lymphatic
Form # | Form Name |
---|---|
21-0960B-1 | Hairy Cell and Other B-Cell Leukemias |
21-0960B-2 | Hematologic and Lymphatic Conditions, including Leukemia |
Infectious Diseases
Form # | Form Name |
---|---|
21-0960I-1 | Persian Gulf and Afghanistan Infectious Diseases |
21-0960I-2 | HIV-Related Illnesses |
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
Form # | Form Name |
---|---|
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 Conditions, Including Flatfoot (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
Form # | Form Name |
---|---|
21-0960C-1 | Parkinson’s Disease |
21-0960C-2 | Amyotrophic Lateral Sclerosis (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 Sclerosis (MS) |
21-0960C-10 | Peripheral Nerve Conditions (Not Including Diabetic Sensory-Motor Peripheral Neuropathy) |
21-0960C-11 | Seizure Disorders |
Ophthalmological
Form # | Form Name |
---|---|
21-0960N-2 | Eye Conditions |
Psychological
Form # | Form Name |
---|---|
21-0960P-1 | Eating Disorders |
21-0960P-2 | Mental Disorders (other than PTSD) |
21-0960P-3 | Review Post Traumatic Stress Disorder (PTSD) |
Respiratory
Form # | Form Name |
---|---|
21-0960L-1 | Respiratory Conditions (other than Tuberculosis and Sleep Apnea) |
21-0960L-2 | Sleep Apnea |
Rheumatological
Form # | Form Name |
---|---|
21-0960Q-1 | Chronic Fatigue Syndrome |
General Surgery
Form # | Form Name |
---|---|
21-0960H-1 | Hernias (including Abdominal, Inguinal, and Femoral Hernias) |
21-0960H-2 | Rectum and Anus Conditions (including Hemorrhoids) |