Public Disability Benefits Questionnaires and other VA forms for clinicians, plus TRICARE and CHAMPVA authorization and medical necessity forms.
Disability Benefits Questionnaires (DBQs) let a veteran's own clinician document a condition so VA can decide service connection and assign a disability rating. They range from back, knee, foot and headache DBQs to hypertension, sleep apnea and mental disorders. Beyond the DBQs, VA Form 21-2680 records the exam for housebound status or aid and attendance, and community care providers use VA Form 10-10172 to request services not on the original referral. TRICARE and CHAMPVA forms round out the list.
A DBQ is a fillable PDF that you complete in full and sign with your NPI, license and specialty. It goes to the veteran, who uploads it with the claim on VA.gov or mails it. VA does not pay for DBQs, so any fee is between the veteran and the provider, and VA may still order its own exam. TRICARE pharmacy forms go to Express Scripts, and TRICARE East authorizations to Humana Military. Vero Documents fills DBQs from the visit note and the chart; you review and sign.
Documents the Veteran's thoracolumbar spine conditions, including range of motion, radiculopathy and incapacitating episodes so VA can decide service connection and assign a disability rating.
Documents the Veteran's foot conditions including flatfoot (pes planus), plantar fasciitis and other foot injuries so VA can decide service connection and assign a disability rating.
Documents the Veteran's headaches including migraines, frequency of prostrating attacks and work impact so VA can decide service connection and assign a disability rating.
Documents the Veteran's hypertension or isolated systolic hypertension, including blood pressure readings on 3 different days so VA can decide service connection and assign a disability rating.
Documents the Veteran's knee and lower leg conditions, including range of motion, instability and meniscal conditions so VA can decide service connection and assign a disability rating.
Documents the Veteran's mental disorders (other than PTSD and eating disorders) under DSM-5, including occupational and social impairment so VA can decide service connection and assign a disability rating.
Documents the Veteran's cervical spine conditions, including range of motion and radiculopathy so VA can decide service connection and assign a disability rating.
Documents the Veteran's peripheral nerve conditions (radiculopathy, neuropathy, nerve injuries) other than diabetic neuropathy so VA can decide service connection and assign a disability rating.
Documents the Veteran's the current severity of already service-connected PTSD (review/increase claims) so VA can decide service connection and assign a disability rating.
Documents the Veteran's scars and disfigurement (size, location, pain, instability) so VA can decide service connection and assign a disability rating.
Documents the Veteran's shoulder and arm conditions, including range of motion so VA can decide service connection and assign a disability rating.
Documents the Veteran's sleep apnea, including sleep study confirmation and CPAP use so VA can decide service connection and assign a disability rating.
Documents the Veteran's ankle conditions, including range of motion, flare-ups and repetitive-use testing so VA can decide service connection and assign a disability rating.
Documents the Veteran's arterial and venous conditions, including varicose veins so VA can decide service connection and assign a disability rating.
Documents the Veteran's diabetes mellitus, treatment (insulin, regulation of activities) and complications so VA can decide service connection and assign a disability rating.
Documents the Veteran's diabetic sensory-motor peripheral neuropathy of the extremities so VA can decide service connection and assign a disability rating.
Documents the Veteran's ear conditions, including vestibular (vertigo/Meniere's) and infectious conditions so VA can decide service connection and assign a disability rating.
Documents the Veteran's esophageal conditions including GERD and hiatal hernia so VA can decide service connection and assign a disability rating.
Documents the Veteran's eye conditions, including visual acuity and visual fields so VA can decide service connection and assign a disability rating.
Documents the Veteran's fibromyalgia so VA can decide service connection and assign a disability rating.
Documents the Veteran's hand and finger conditions, including range of motion and ankylosis so VA can decide service connection and assign a disability rating.
Documents the Veteran's heart conditions (ischemic heart disease, arrhythmias, valvular disease, cardiac surgery), including METs/functional capacity so VA can decide service connection and assign a disability rating.
Documents the Veteran's hip and thigh conditions, including range of motion so VA can decide service connection and assign a disability rating.
Documents the Veteran's intestinal conditions (IBS, IBD, intestinal surgery, infections) so VA can decide service connection and assign a disability rating.
Documents the Veteran's male reproductive organ conditions including erectile dysfunction and prostate cancer so VA can decide service connection and assign a disability rating.
Documents the Veteran's respiratory conditions (asthma, COPD, interstitial lung disease, etc.), including PFT results so VA can decide service connection and assign a disability rating.
Documents the Veteran's sinusitis, rhinitis and other conditions of the nose, throat, larynx and pharynx so VA can decide service connection and assign a disability rating.
Documents the Veteran's skin diseases (dermatitis, eczema, psoriasis, etc.), body-area coverage and treatment so VA can decide service connection and assign a disability rating.
Documents the Veteran's wrist conditions, including range of motion so VA can decide service connection and assign a disability rating.
Documents the Veteran's amputations (level, prosthesis use, residual limb) so VA can decide service connection and assign a disability rating.
Documents the Veteran's amyotrophic lateral sclerosis (ALS) so VA can decide service connection and assign a disability rating.
Documents the Veteran's bone and other skeletal conditions so VA can decide service connection and assign a disability rating.
Documents the Veteran's breast conditions and disorders, including breast surgery so VA can decide service connection and assign a disability rating.
Documents the Veteran's central nervous system and neuromuscular diseases not covered by a more specific DBQ so VA can decide service connection and assign a disability rating.
Documents the Veteran's chronic fatigue syndrome so VA can decide service connection and assign a disability rating.
Documents the Veteran's cranial nerve diseases so VA can decide service connection and assign a disability rating.
Documents the Veteran's eating disorders so VA can decide service connection and assign a disability rating.
Documents the Veteran's elbow and forearm conditions, including range of motion so VA can decide service connection and assign a disability rating.
Documents the Veteran's endocrine diseases other than thyroid, parathyroid or diabetes so VA can decide service connection and assign a disability rating.
Documents the Veteran's gallbladder conditions so VA can decide service connection and assign a disability rating.
Documents the Veteran's gynecological conditions so VA can decide service connection and assign a disability rating.
Documents the Veteran's hematologic and lymphatic conditions, including leukemia and lymphoma so VA can decide service connection and assign a disability rating.
Documents the Veteran's hepatitis, cirrhosis and other liver conditions so VA can decide service connection and assign a disability rating.
Documents the Veteran's abdominal, inguinal and femoral hernias so VA can decide service connection and assign a disability rating.
Documents the Veteran's HIV-related illnesses so VA can decide service connection and assign a disability rating.
Documents the Veteran's infectious diseases other than HIV, chronic fatigue syndrome or tuberculosis so VA can decide service connection and assign a disability rating.
Documents the Veteran's kidney conditions (renal dysfunction, dialysis, stones) so VA can decide service connection and assign a disability rating.
Documents the Veteran's loss of the sense of smell and/or taste so VA can decide service connection and assign a disability rating.
Documents the Veteran's multiple sclerosis so VA can decide service connection and assign a disability rating.
Documents the Veteran's muscle injuries by muscle group so VA can decide service connection and assign a disability rating.
Documents the Veteran's narcolepsy so VA can decide service connection and assign a disability rating.
Documents the Veteran's non-degenerative arthritis (inflammatory, autoimmune, crystalline, infectious) and decompression illness so VA can decide service connection and assign a disability rating.
Documents the Veteran's nutritional deficiencies so VA can decide service connection and assign a disability rating.
Documents the Veteran's oral and dental conditions of the mouth, lips and tongue so VA can decide service connection and assign a disability rating.
Documents the Veteran's osteomyelitis so VA can decide service connection and assign a disability rating.
Documents the Veteran's pancreas conditions so VA can decide service connection and assign a disability rating.
Documents the Veteran's Parkinson's disease and its manifestations so VA can decide service connection and assign a disability rating.
Documents the Veteran's peritoneal adhesions so VA can decide service connection and assign a disability rating.
Documents the Veteran's presumptive infectious diseases from Persian Gulf/Afghanistan service so VA can decide service connection and assign a disability rating.
Documents the Veteran's rectum and anus conditions (hemorrhoids, fistula, sphincter impairment) so VA can decide service connection and assign a disability rating.
Documents the Veteran's seizure disorders (epilepsy) so VA can decide service connection and assign a disability rating.
Documents spina bifida findings in the natural child of a Veteran exposed to herbicides so VA can assign the child's monthly allowance level.
Documents the Veteran's stomach and duodenal conditions (ulcer disease, gastritis, post-gastrectomy) so VA can decide service connection and assign a disability rating.
Documents the Veteran's systemic lupus erythematosus and other autoimmune diseases so VA can decide service connection and assign a disability rating.
Documents the Veteran's temporomandibular disorders so VA can decide service connection and assign a disability rating.
Documents the Veteran's thyroid and parathyroid conditions so VA can decide service connection and assign a disability rating.
Documents the Veteran's tuberculosis so VA can decide service connection and assign a disability rating.
Documents the Veteran's urinary tract conditions including bladder and urethra (voiding dysfunction, incontinence) so VA can decide service connection and assign a disability rating.
Records a physical examination showing whether the Veteran, spouse, surviving spouse or parent is housebound or needs the regular aid and attendance of another person, for the A&A/Housebound add-on to compensation or pension.
VA Form 10-10172Community care provider asks VA to authorize services not on the original referral (extra visits, new specialty care, procedures, home/long-term care) or DME, prosthetics, home oxygen and therapeutic footwear.
State Veterans Home physician certifies the Veteran's diagnoses, functional evaluation and the type of care needed (nursing home, domiciliary or adult day health care) so VA can pay State Home per diem.
VA Form 10-10068bTreating physician documents a family member's diagnosis of one of the 15 covered Camp Lejeune conditions, treatment and dates so VA can decide eligibility for reimbursement under the Camp Lejeune Family Member Program.
Claims total disability insurance benefits / premium waiver under a Government Life Insurance policy; Part II is the attending practitioner's report of diagnosis, findings, treatment and prognosis.
Prescriber justifies a formulary drug with prior authorization criteria or a non-formulary drug (medical necessity) so TRICARE covers it at network and home-delivery pharmacies (PA also at military pharmacies).
Prescriber explains the patient's experience with the A-rated generic and clinical justification for dispensing the brand-name drug.
Ordering provider certifies medical necessity, HCPCS codes, quantity and length of need for durable medical equipment (incl. CPAP and capped rentals) for TRICARE East claims.
Diagnosing provider documents that DSM-5 autism spectrum disorder criteria are met (with/without intellectual or language impairment, comorbidities) for the Autism Care Demonstration.
Ordering provider attests diabetes diagnosis, insulin regimen, diabetes education and recent in-person evaluation for initial TRICARE CGM approval or replacement receiver.
ABA supervisor submits the initial assessment and treatment plan to obtain TRICARE ACD authorization for ABA services.
Ordering provider attests that the beneficiary meets TRICARE criteria for a laboratory developed test (incl. genetic tests), with CLIA lab details and codes.
Requests extension of an existing TRICARE behavioral health authorization with updated diagnoses, medications, clinical progress and discharge plan.
Requests initial TRICARE authorization for inpatient, residential (non-RTC), partial hospitalization, intensive outpatient or substance use disorder treatment.
Referring provider documents a definitive autism spectrum disorder diagnosis, severity, comorbidities and validated assessment tool so a child can enter ABA under the TRICARE Comprehensive Autism Care Demonstration (ACD).
Notifies Humana Military of a behavioral health discharge, with discharge plan and 7-day and 30-day follow-up appointments.
Requests TRICARE authorization (initial or extension) for electroconvulsive therapy with clinical summary and treatment response.
Requests TRICARE authorization for outpatient/ambulatory opioid and substance use disorder treatment.
Documents the infant condition and 30-day prescription (quantity, frequency) needed for TRICARE coverage of banked donor human milk.
Concurrent review and discharge planning information to continue an authorized RTC stay.
Requests initial TRICARE authorization for psychiatric residential treatment center care for a beneficiary under 21.
Requests initial TRICARE authorization for Spravato (esketamine) nasal spray for treatment-resistant depression.
Requests continued TRICARE authorization for Spravato (esketamine) treatment.
Requests TRICARE authorization for TMS for depression, documenting failed antidepressant trials, psychotherapy history and contraindications.
Prescriber documents active ingredients, diagnosis, route and why a compounded product is needed instead of a commercial product, for TRICARE coverage of compounds.
Prescriber justifies retail-pharmacy fills of drugs in the special non-formulary (non-Federal Ceiling Price) class, which otherwise cost 100% at retail.
Physician order/certificate of medical necessity that must accompany CHAMPVA claims for certain durable medical equipment (e.g., insulin pumps, barrier-free lifts).
Provider obtains CHAMPVA approval before non-emergent inpatient mental health/substance use care, RTC, PHP, IOP, dental care, organ and bone marrow transplants and other services listed in the CHAMPVA Guidebook.
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 and their requirements change without notice, so check the official page for the current version before you complete one.
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Yes, for the public DBQs. The veteran's treating or examining provider, such as an MD, DO, NP, PA or other licensed clinician, completes the whole form and signs and dates it with NPI, license number and specialty. The completed DBQ goes to the veteran, who uploads it with the claim on VA.gov or mails it to the VA Evidence Intake Center; a representative may also submit it. VA may verify the form.
The Initial PTSD DBQ and the Hearing Loss and Tinnitus DBQ are restricted to VA and contract examiners, and the traumatic brain injury DBQs are not public. The Review PTSD DBQ is public, for PTSD that is already service connected, and is completed by a psychiatrist or licensed doctorate-level psychologist, or by an LCSW, NP, CNS or PA under close supervision. The Mental Disorders DBQ covers other conditions, excluding PTSD and eating disorders.
An examining MD, DO, physician assistant or advanced practice registered nurse. The claimant completes Sections I to V, and the examiner completes Sections VI to VIII: findings, activities of daily living, whether the patient can manage benefit payments, and the examiner's signature and NPI. The form supports the aid and attendance or housebound add-on to compensation or pension, and is often paired with a nursing home's VA Form 21-0779.
Pharmacy forms go to Express Scripts, the TRICARE Pharmacy Program contractor: drug-specific prior authorization and medical necessity forms, brand over generic requests and compounded medication requests. In the TRICARE East Region, Humana Military takes forms such as the CGM attestation, ABA referral, TMS and Spravato requests, uploaded through its provider self-service portal. Prior authorization and medical necessity are separate reviews, and a drug may need both.