Disability benefits questionnaires (dbqs) pdf download

To enter and activate the submenu links, hit the down arrow. Get help from Veterans Crisis Line. Enter your search text Button to start search. Paul St. Do not schedule more than two DBQ exams in one visit; your Dr. If you need to schedule multiple visits; Do So! Doing this will allow Dr. Having only a min exam is insufficient time for your doctor to review your medical records and fill out the 5-page DBQ. Hepatitis, Cirrhosis and Other Liver Conditions Evaluation of peritoneal adhesions, which are scars of the visceral lining of the abdominal structures that produces episodes of partial or complete bowel obstruction.

Peritoneal Adhesions Evaluation of stomach and duodenum conditions such as peptic ulcer disease, recurrent pain relieved by antacids, bloody stools, nausea or vomiting, indigestion. Stomach and Duodenum Conditions not including GERD or Esophageal Disorders Evaluation of Amebiasis, dysentery, and various types of intestinal parasites with recurrent diarrhea, alteration in stool consistency or foul smell. Infectious Intestinal Disorders, including Bacterial and Parasitic Infections Evaluation of removal of portions of the intestine and reconstruction and diversion of the intestinal tract: bowel diversion that requires use of external bags to collect stool.

Intestinal Surgery Bowel Resection, Colostomy, and Ileostomy Genitourinary Conditions — Symptoms Form Name Evaluation of renal diseases including Nephritis, renal insufficiency, and other diseases of the kidney: kidney failure, abnormal kidney function tests, protein in the urine, edema, kidney stones. Kidney Conditions Nephrology Evaluation of diseases of the urethra, penis, testes, and scrotum, producing pain on urination, swelling, blood in urine or incontinence.

Male Reproductive Organ Conditions Evaluation of malignant lesions of the prostate gland with frequent diurnal or nocturnal urination. Prostate Cancer Evaluation of conditions affecting the bladder and urethra, including, but not limited to voiding dysfunctions and infections.

Breast Conditions and Disorders Evaluation of diseases of the female genital tract including: uterus, vagina, cervix, ovaries, endometriosis, complications of pregnancy, and other conditions. Gynecological Conditions Hematologic and Lymphatic Conditions — Symptoms Form Name Evaluation of conditions of red and white blood cells, producing anemias, leukemias on tumors such as lymphomas.

Infectious Diseases Evaluation of infectious diseases associated with military service in tropical areas with exposure to salmonella, shigella, etc. Tuberculosis TB For use in evaluation of vitamin deficiencies Beriberi, Pellagra, syndromes of dermatitis, diarrhea dementia in POW, post-GI surgery, bypass procedures, undernutrition and malabsorption.

Nutritional Deficiencies Musculoskeletal Conditions — Symptoms Form Name Evaluation of extremity, limb or digit complete or partial amputation , and complications. Evaluation of stumps. Amputations Evaluation of ankle pain, persistent deformity ankylosis , ankle injuries, reduction of movement, and use of assistive device. Ankle Conditions Evaluation for non-degenerative arthritic conditions such as Gout and Rheumatoid Arthritis: recurrent painful and swollen joints.

Non-degenerative Arthritis including Inflammatory, Autoimmune, Crystalline, and Infectious Arthritis and Dysbaric Osteonecrosis Evaluation of injuries, deformities, loss of elbow and forearm producing motion limitation. Elbow and Forearm Conditions Evaluation of flatfoot, and acquired deformity of the foot. Flatfoot Pes Planus Evaluation of reduction or loss of toe function and motion, and alteration in mobility. Foot Miscellaneous other than Flatfoot Evaluation of alteration in motion of the wrists or digits due to tendon or muscle injuries, and alteration in motion and function of the hand including ankylosis, trigger finger, loss of finger movement.

Hand and Finger Conditions Evaluation of alteration in extension and flexion, poor postural and body support, and alteration of rotation of the hip. Hip and Thigh Conditions Evaluation of ankylosis of the knee, subluxation of the knee, knee instability, meniscus lesions, and functional limitations knee cartilage problems, locked knee.

Knee and Lower Leg Conditions Evaluation of traumatic and other injuries resulting in loss or alteration of function, location, type, tears, and weakness: torn scarred muscles. Muscle Injuries Evaluation of bone infections producing fever, local alteration of function, residuals from a bone infection with persistent drainage or bone alteration Osteomyelitis Evaluation of arm limitation of function, dislocation, alteration in joint function, incomplete movements, deformity, dislocation, nonunion, and fracture complications : frozen shoulder.

Shoulder and Arm Conditions Evaluation of arthritis and neck deformities. Neck Cervical Spine Conditions Evaluation of unfavorable or incomplete wrist motion due to ankylosis limitation in range , painful or other alteration in function, resulting from traumatic or other injury complications, joint replacement.

Wrist Conditions Evaluation of chronic low back pain, arthritis and back injuries, spinal conditions or disc disease: low back pain with sciatica. Back Thoracolumbar Spine Conditions Neurological Conditions — Symptoms Form Name Evaluation of progressive degenerative disease of the brain and spinal cord with progressive muscle weakness and wasting, speech, swallowing and breathing problems. Diabetic Sensory-Motor Peripheral Neuropathy Evaluation of numerous other neurologic conditions such as: meningitis, HIV, brain abscess, Lyme Disease, encephalitis, stroke, brain tumor, and spinal cord injury.

Cranial Nerve Conditions Evaluation of recurrent episodes of head pain producing work limitation or incapacitation: with other symptoms such as nausea, vomiting, tearing etc. Headaches including Migraine Headaches Evaluation of fibromyalgia components, including, but not limited to sleep problems, muscle and joint pain, and altered affect.

Fibromyalgia Evaluation of disorders of the myelin sheath of the central nervous systems producing recurrent alterations of neurological function: such as weakness, numbness, urine incontinence, visual symptoms.

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