Veterans Affairs Canada uses 50 condition-specific questionnaires, numbered PEN 56 to PEN 6268, to confirm a diagnosis and assess it against the Table of Disabilities for disability benefits. A clinician meets one when a Veteran brings the questionnaire VAC has specified for a claimed or entitled condition. You complete only the sections relevant to that condition, and VAC combines your findings with the other medical evidence on file.
A health professional authorized to diagnose within their scope completes the questionnaire or writes a detailed report covering the same items: a GP, specialist or nurse practitioner for most conditions, and physician assistants only in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Prince Edward Island. Chiropractors, podiatrists, audiologists, psychologists, psychiatrists, dentists, ophthalmologists and optometrists complete those for their own field.
Enter the client's name, date of birth, mailing address, VAC file number and decision number, plus the date of your examination. Use the questionnaire VAC named, since VAC asks that none be completed before it gives specific instructions. Fields marked with an asterisk are required, and the privacy notice warns that an incomplete form may delay the Veteran's claim.
Condition-specific questionnaires let you either complete the questionnaire (Option 1) or submit a detailed report that includes all the information it requests (Option 2). A narrative report only works if it covers every item, because VAC needs very specific information that may not be part of a usual clinical history. Either way, complete only what is relevant to the claimed or entitled condition.
List the confirmed diagnoses of the claimed or entitled condition. The General Medical Questionnaire (PEN 71) also asks whether each diagnosis is confirmed or provisional and whether you expect further medical improvement, with an approximate time frame. Diagnoses must come from a professional authorized to diagnose in that area; physiotherapists and some counsellors may assess but not diagnose.
Describe current symptoms with their frequency, duration, and aggravating and relieving factors, and the client's functional ability as it relates to the condition. Note injuries with their dates. Musculoskeletal forms such as the cervical spine questionnaire ask separately about non-radicular and radicular pain, whether it is daily, weekly or intermittent, and how severe it is.
Give a complete medication list with dosage, frequency, duration, route and response, then surgery or hospitalization with dates and response, and other treatment such as physiotherapy. Say whether further diagnostic tests or consultations are ongoing or planned, with the appointment date if known, and attach or forward copies of relevant reports, such as diagnostic, consultation, operative, laboratory and hospital discharge summaries.
Record complications resulting from the claimed or entitled condition and any other conditions contributing to the client's impairment, indicating to what degree they contribute. PEN 71 asks for these under Complications and Other pertinent findings; the cervical spine questionnaire combines them in one box. VAC combines your answers with the other medical information it holds to describe the current disability.
PEN 71 asks for height, weight, blood pressure, pulse, respiration, general appearance, and examination findings with functional limitations. Condition-specific forms ask for measured findings: the cervical spine questionnaire, for example, wants active range of motion in degrees against stated normals such as 60° of flexion, any ankylosis, and an upper-limb neurological exam with motor power graded 0 to 5 and reflexes graded 0 to 4.
Give your name, mailing address and telephone number, answer "Is VAC to be invoiced?", then sign and date. VAC accepts wet, digital or stamped signatures, not typed signatures or clinic stamps. Professionals outside Canada are accepted if they are licensed and authorized by the regulator in their country of practice.
Download the current version from the source each time; forms change without notice.
Medical questionnaires for disability benefits (50 condition-specific forms)
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
Sources for this guide
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A professional authorized to diagnose conditions in their area and registered in good standing. GPs, specialists and nurse practitioners can complete most questionnaires; physician assistants only in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Prince Edward Island. Chiropractors, podiatrists (foot and toe only), audiologists, psychologists, psychiatrists, dentists, ophthalmologists and optometrists are limited to their own field.
Yes. VAC reimburses the provider or the applicant for each completed questionnaire used in a disability benefit application or reassessment, at a reasonable rate based on the provincially recommended fee for uninsured third-party requests. Tick yes to "Is VAC to be invoiced?" Work VAC did not request, or beyond what it requested, is not reimbursed as billed.
Yes. Questionnaires such as Cervical Spine Conditions (PEN 6236) offer two options: complete the questionnaire, or submit a detailed report that includes all the information it requests. VAC's FAQ also accepts a diagnostic narrative report with the same information if a provider won't complete the form. Either way, attach relevant diagnostic, consultation or discharge reports.
VAC accepts a wet signature, a digital signature or a stamped signature. Typed signatures and clinic stamps that identify the signer or clinic are not valid, and a report without a valid signature is rejected. Reports outside the practitioner's scope of practice, or that fall short of usual medical practice standards, may also be rejected.