Esophageal Disorders Archives » VA Disability Claims

Disability Benefits Questionnaire (DBQ) Veterans now have more control over the disability claims process. Veterans have the option of visiting a private health care provider instead of a VA facility to complete their disability evaluation form.

Veterans can have their providers fill out any of the more than 70 DBQs that are appropriate for their conditions and submit them to us. It’s that easy!

Source: www.benefits.va.gov

Current as of 09/05/207 Check here for the latest Disability Benefits Questionnaire (DBQ)

Cardiovascular

Conditions – Symptoms	Form Name
Evaluation of varicose veins, arterial diseases, producing swelling, claudication of legs, or pain on walking, skin/nail changes	Artery and Vein Conditions (Vascular Diseases including varicose veins)
Evaluation of high blood pressure (BP): how to determine significance of BP readings or BP reading abnormalities.	Hypertension
Conditions including: heart attack (MI), irregular rhythm, heart murmurs and heart surgery.	Heart Conditions (Including IHD, Non-IHD, Arrhythmias Valvular Disease and Cardiac Surgery)

Dental and Oral

Conditions – Symptoms	Form Name
Evaluation of all dental and oral conditions, except TMJ Conditions.	Dental and Oral Conditions
Evaluation of conditions affecting the TMJ joint with pain in the jaw when biting and clicks and sounds in the jaw.	Temporomandibular Joint (TMJ) Conditions

Dermatological

Conditions – Symptoms	Form Name
Evaluation for infectious and non-infectious diseases of the skin: how to evaluate rashes, spots, athlete’s foot, sweating, and acne skin lesions.	Skin Diseases
Evaluation of palpable or disfiguring scars, producing distortion or asymmetry.	Scars and Disfigurement

Ear, Nose, and Throat

Conditions – Symptoms	Form Name
Evaluation of various conditions of the ear including: infections, dizziness, vertigo, acoustic tumors and other conditions with ringing in the ears (tinnitus).	Ear Condition (including: Vestibular and Infectious Conditions)
Evaluation of Anosmia (inability to detect any odor), Hyposmia (reduced ability to detect odors), Ageusia (complete lack of taste), Hypogeusia (decrease in sense of taste) and other conditions affecting the sense of smell and taste.	Loss of Sense of Smell and/or Taste
Evaluation of conditions affecting, the sinuses, nose, throat, larynx, and pharynx, including, but not limited to deviated nasal septum and organic aphonia, vocal chord problems.	Sinusitis, Rhinitis, and other Conditions of the Nose, Throat, Larynx, and Pharynx

Endocrinological

Conditions – Symptoms	Form Name
Evaluation of DM Type I or II, with alteration of blood sugar regulation, abnormal Glucose Tolerance Test (GTT), requiring medication or hospitalization or complications.	Diabetes Mellitus (DM)
Evaluation of conditions affecting the hormone glands, including, but not limited to Cushing’s syndrome, Acromegaly, and Addison’s Disease.	Endocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus)
Evaluation of conditions affecting the functions regulated by the thyroid and parathyroid glands, including, but not limited to growth and metabolism.	Thyroid and Parathyroid Conditions

Gastrointestinal

Conditions – Symptoms	Form Name
Evaluation of conditions affecting the esophagus such as stricture, spasm, or other conditions with lump in throat or chest, pain on swallowing, or regurgitation.	Esophageal Conditions (including GERD, Hiatal Hernia, and Other Esophageal Disorders)
Evaluation of gallbladder disease, with inflammation, gallstones, pain after eating fatty food, or pancreatic conditions including pancreatitis that manifests as severe recurrent abdominal pain.	Gallbladder and Pancreas Conditions
Evaluation of Irritable Bowel Syndrome (IBS) (chronic recurrent diarrhea or constipation). Ulcerative colitis (chronic inflammatory bowel condition leading to erosions and bleeding) and other conditions with Bloody stools, fistulas, and/or abscess.	Intestinal Conditions (other than surgical or infectious) including Irritable Bowel Syndrome, Crohn’s Disease, Ulcerative Colitis, and Diverticulits
Evaluation of hepatitis (which refers to a variety of inflammatory and infectious conditions) and Cirrhosis (chronic liver disease resulting from liver injury leading to degeneration of the liver)and other conditions characterized by jaundice, ascitis, fluid retention.	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.	Urinary Tract (Bladder and Urethra)

Gynecological

Conditions – Symptoms	Form Name
Evaluation of inflammatory neoplastic and cystic lesions of the breast: Breast mass or lumps.	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.	Hematologic and Lymphatic Conditions

Infectious Diseases

Conditions – Symptoms	Form Name
Evaluation of conditions associated with the Human Immunodeficiency Virus (HIV) and its treatment.	HIV-Related Illnesses
Evaluation of infectious diseases not specifically-associated with either HIV or military service in a tropical area, the Persian Gulf, or Afghanistan.	Infectious Diseases
Evaluation of infectious diseases associated with military service in tropical areas with exposure to salmonella, shigella, etc. producing symptoms such as chronic diarrhea.	Persian Gulf and Afghanistan Infectious Diseases
Evaluation of conditions in which the immune system begins attacking healthy body tissues, including, but not limited to, Goodpasture’s syndrome and Guillain-Barre syndrome.	Systemic Lupus Erthematosus (SLE) and Other Autoimmune Diseases
Evaluation of pulmonary and extrapulmonary tuberculosis symptoms.	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 reduction or loss of toe function and motion, and alteration in mobility.	Foot conditions including flatfoot (pes planus)
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.	Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease)
Evaluation of alteration of the function of the nerves (motor and sensory), related to Diabetes Mellitus: weakness, numbness, tingling of legs and arms related to diabetes.	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.	Central Nervous System and Neuromuscular Diseases (except TBI, ALS, Parkinson’s Disease, MS, Headaches, TMJ, Epilepsy, Narcolepsy, Peripheral Nerves, Sleep Apnea, Cranial Nerves, Fibromyalgia, and Chronic Fatigue Syndrome)
Evaluation of conditions affecting the following nerves in the Cranium: V (trigeminal, VII (facial), IX (glossopharyngeal), X (vagus), XI (spinal accessory), and XII (hypoglossal). (Conditions affecting cranial nerves I (olfactory), II (optic), III (oculomotor), IV (trochlear), VI(abducens), and VIII (vestibulocochlear (auditory)) are addressed in other DBQs.)	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.	Multiple Sclerosis (MS)
Evaluation of symptoms that may include tremors, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.	Parkinson’s Disease
Evaluation of narcolepsy components, including, but not limited to, sleep attacks, sleepiness, paralysis, and cataplexy.	Narcolepsy
Evaluation of alteration of the function of Nerves associated with metabolic disorders, exposure to toxins, infections, immunological disorders, or inflammation and other conditions.	Peripheral Nerve Conditions (not including Diabetes Sensory-Motor peripheral Neuropathy)
Evaluation of seizure conditions including epilepsy.	Seizure Disorders

Ophthalmological

Conditions – Symptoms	Form Name
Evaluation of various diseases of the eye, such as inflammation, infection, glaucoma, deformities, alteration of tear ducts, cataracts, retina disease, and other conditions.	Eye Conditions

Psychological

Conditions – Symptoms	Form Name
Evaluation for anorexia, bulimia, and other eating disorders.	Eating Disorders
Evaluation of symptoms, history, and impact related to mental disorders: depression, mood and affective disorders, psychosis, etc.	Mental Disorders (other than PTSD)
Evaluation of beginning and extent of symptoms (acute – length of symptoms is usually less than 3 months, chronic – symptoms usually last 3 months or more, with delayed onset – usually at least 6 months have passed between the traumatic experience and the beginning of symptoms). Symptoms may include: recurrent experiences of a traumatic event, avoiding an excitant or irritant associated with the trauma, deadening of general responsiveness, increased arousal, including insomnia, recurrent nightmares, and extreme caution; exhibiting an inflated frightened response; and experiencing changes in hostility..	Review Evaluation of PTSD

Respiratory

Conditions – Symptoms	Form Name
Evaluation of the respiratory system except Sleep Apnea and Tuberculosis.	Respiratory Conditions (other than TB and Sleep Apnea)
Evaluation of disorder characterized by cessation of breathing during sleep and provides information necessary to determine functional impact (sleep apnea, snoring) daytime complications.	Sleep Apnea

Rheumatological Diseases

Conditions – Symptoms	Form Name
Evaluation of Chronic Fatigue Syndrome. Components including but not limited to tiredness, loss of memory or concentration and enlarged lymph nodes.	Chronic Fatigue Syndrome

General Surgical

Conditions – Symptoms	Form Name
Evaluation of conditions involving internal organs bulging through the muscle, except hiatal hernia.	Hernias (including Abdominal, Inguinal, and Femoral Hernias)
Evaluation of rectum and anus conditions causing alteration of sphincter control, stricture of prolapse, fistula, and other symptoms. Bowel incontinence or severe constipation blood in stools.	Rectum and Anus Conditions (including Hemorrhoids)

Esophageal Disorders

List By Symptom – VA Disability Compensation

Cardiovascular

Dental and Oral

Dermatological

Ear, Nose, and Throat

Endocrinological

Gastrointestinal

Genitourinary

Gynecological

Hematologic and Lymphatic

Infectious Diseases

Musculoskeletal

Neurological

Ophthalmological

Psychological

Respiratory

Rheumatological Diseases

General Surgical

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