Disability Benefits Questionnaires - List By Form

United States Department of Veterans Affairs

Disability Benefits Questionnaires - List By DBQ Form Name

Disability Benefits Questionnaires (DBQs) are medical examination forms used to capture essential information for evaluating disability compensation and/or pension claims.

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Cardiovascular

Form #	Form Name
21-0960A-1	Ischemic Heart Disease (IHD)
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

Form #	Form Name
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

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-5	Flatfoot (Pes Planus)
21-0960M-6	Foot Miscellaneous (other than 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)