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VA Artery and Vein Conditions DBQ (Vascular Diseases)

Veterans claiming VA compensation for vascular disease can have their provider complete this 10-page public DBQ. It covers varicose veins and post-phlebitic syndrome, peripheral arterial disease and Buerger's disease, aneurysms of large, small and aortic arteries, Raynaud's, AV fistula, angioneurotic edema and erythromelalgia, plus vascular tumors, amputations and diagnostic testing. VA uses it to decide service connection and the rating.

Who completes it

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

Submitting and payment

How to submit it
The Veteran uploads the signed DBQ with the claim on VA.gov or mails it to VA's Evidence Intake Center; a representative can also file 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 XIII asks for ankle/brachial index results; if ABI does not reflect PAD severity, ankle pressure, toe pressure or TcPO2 testing is required when not already of record.
  • Venous symptoms and findings, such as aching after prolonged standing, stasis pigmentation, edema or ulceration, are checked by affected extremity.
  • Raynaud's items ask attack frequency, digital ulcers and auto-amputation; an erythromelalgia attack is defined as burning pain in the hands, feet or both.
  • The current version was updated 2024-07-09 (v24_1), and the examiner's certification and signature is Section XVI.

Get the official form

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

Artery and Vein Conditions (Vascular Diseases Including Varicose Veins) 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.

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Frequently asked questions

Is ABI testing required on the artery and vein DBQ?

Section XIII asks whether ankle/brachial index testing was performed and for the most recent results by side. If ABI alone does not reflect the severity of peripheral arterial disease and the examiner says ankle pressure, toe pressure or TcPO2 testing is needed and not of record, that testing is required.

Which conditions does the VA artery and vein DBQ cover?

Varicose veins and post-phlebitic syndrome, peripheral arterial disease and Buerger's disease, aneurysms of a large artery, the aorta or a small artery, Raynaud's disease or syndrome, traumatic AV fistula, angioneurotic edema and erythromelalgia, along with related neoplasms, amputations and scars.

Will VA accept a private doctor's artery and vein DBQ?

VA considers DBQs completed by the Veteran's own provider as evidence. It reserves the right to confirm the authenticity of every questionnaire and may still order its own examination if more information is needed, and the Veteran must attend any exam VA schedules.