DISABILITY BENEFITS QUESTIONNAIRES LIST BY DBQ …

1 D ISABILITY B ENEFITS Q UESTIONNAIRES - L IST B Y DBQ F ORM N AME. DISABILITY BENEFITS QUESTIONNAIRES (DBQs) are medical examination forms used to capture essential information for evaluating DISABILITY compensation and/or pension claims. Tip: To do a quick search, hold down the "Ctrl" key and click on the "F" key. Enter your search in the text box and click next. 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 Heart Conditions (including IHD, Non-IHD, Arrhythmias, Valvular Disease 21-0960A-4. and Cardiac Surgery). Dental and Oral form # form Name 21-0960M-15 Temporomandibular Joint (TMJ) Conditions Oral and Dental Conditions, including Mouth, Lips, and Tongue (other than 21-0960D-1.)

2 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 Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and 21-0960N-4. Pharynx Endocrinological form # form Name 21-0960E-1 Diabetes Mellitus Endocrine Diseases (other than Thyroid and Parathyroid, or Diabetes 21-0960E-2. Mellitus). 21-0960E-3 Thyroid and Parathyroid Conditions Gastrointestinal form # form Name Esophageal Conditions (Including GERD, Hiatal Hernia and Other 21-0960G-1. Esophageal Disorders). 21-0960G-2 Gallbladder and Pancreas Conditions Intestinal Conditions (other than Surgical or Infectious) Including Irritable 21-0960G-3.

3 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 Stomach and Duodenal Conditions (not including GERD or Esophageal 21-0960G-7. 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 Urinary Tract (including Bladder and Urethra) Conditions (excluding Male 21-0960J-4. 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 Infectious Diseases (other than HIV-Related Illness, Chronic Fatigue 21-0960I-3.)

4 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 Non-Degenerative Arthritis (including Inflammatory, Autoimmune, 21-0960M-3. 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).

5 21-0960C-3 Cranial Nerve Conditions 21-0960C-4 Diabetic Sensory-Motor Peripheral Neuropathy Central Nervous System and Neuromuscular Diseases (except TBI, ALS, 21-0960C-5 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). Peripheral Nerve Conditions (Not Including Diabetic Sensory-Motor 21-0960C-10. 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).

6 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).