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VA ALS Disability Benefits Questionnaire (DBQ)

Veterans claiming VA disability compensation for amyotrophic lateral sclerosis can have their own provider complete this public DBQ. Across 16 sections and 12 pages, the provider documents the diagnosis, ALS-related conditions and symptoms, a neurologic exam, housebound status, aid and attendance needs, and whether the Veteran can manage benefit payments. VA uses it to decide service connection and assign a rating.

Who completes it

The Veteran's treating or examining clinician (MD, DO, NP, PA or other licensed clinician) completes the whole form and signs Section XVI with printed name and title, specialty, NPI, medical license number and state, and contact details.

Submitting and payment

How to submit it
Give it to the Veteran, who uploads it with the claim on VA.gov (printed to PDF first) or mails it to VA's Evidence Intake Center; a representative may also submit it.
Who pays
VA does not pay or reimburse any cost of completing a DBQ; any provider fee is between the Veteran and the provider.

Good to know

  • Section III covers systems ALS commonly affects: limb weakness, speech and swallowing, respiratory and sleep apnea-like symptoms, sphincter control, bowel and bladder function, urinary tract infections and sexual function.
  • Section IX asks whether the Veteran needs a higher, more skilled level of aid and attendance, such as injections, catheter placement or sterile dressing changes, without which institutional care would be required.
  • If PFTs in the record reflect current respiratory function, repeat testing is not required; DLCO and bronchodilator testing are not indicated for ALS-related restrictive disease.
  • The current version was updated 2024-11-08 (v24_1). Public DBQs no longer carry a VA form number.

Get the official form

Download the current version from the source each time; forms change without notice.

Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) Disability Benefits Questionnaire

Official pagePDF

How this list is checked

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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Who can fill out the VA ALS DBQ?

VA intends the Veteran's own healthcare provider to complete it. The examiner block asks for printed name and title (such as MD, DO, NP or PA-C), area of practice, NPI, medical license number and state, and signature. VA reserves the right to confirm the authenticity of every completed questionnaire.

Does the ALS DBQ cover aid and attendance?

Yes. Section VII asks whether ALS confines the Veteran to the home, Section VIII covers activities of daily living such as dressing, and Section IX asks about the need for higher-level skilled care. Section XII asks whether the Veteran can manage benefit payments or direct someone else to do so.

Will VA still schedule its own ALS exam?

It can. The DBQ states VA may obtain additional medical information, including an examination, if needed to complete its review. If VA decides another exam is required and schedules one, the Veteran must report for it.