Try for free

VA Breast Conditions and Disorders DBQ

Veterans claiming VA compensation for breast conditions, including breast cancer and breast surgery, can have their provider complete this five-page public DBQ. The provider records diagnoses, any benign or malignant neoplasm, treatment status, the type and side of breast surgery, residuals such as arm swelling, and whether surgery or radiation removed 25 percent or more of breast tissue. 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 form and signs Section IX with name and title, specialty, NPI, medical license number and state.

Submitting and payment

How to submit it
The Veteran uploads the completed DBQ on VA.gov with the claim or mails it to VA's Evidence Intake Center; a representative may 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

  • Surgery choices use VA definitions: wide local excision (including lumpectomy, partial mastectomy and quadrantectomy), simple or total, modified radical and radical mastectomy, plus axillary or sentinel node excision and biopsy.
  • For wide local excision and simple mastectomy, the provider marks by side whether there was significant alteration of form or size.
  • Residual conditions from the neoplasm or its treatment, such as arm swelling or nerve damage, are described briefly and documented on the appropriate separate DBQ.
  • The current version was updated 2024-07-16 (v24_1), and the examiner's certification and signature is Section IX.

Get the official form

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

Breast Conditions and Disorders 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

What does VA mean by wide local excision on the breast DBQ?

For VA purposes, wide local excision means removal of a portion of the breast tissue and includes partial mastectomy, lumpectomy, tylectomy, segmentectomy and quadrantectomy. The provider then marks, by side, whether the excision caused significant alteration of form or size.

Why does the breast DBQ ask about 25 percent tissue loss?

Section IV asks whether surgery or radiation treatment resulted in the loss of 25 percent or more of tissue from a single breast or both breasts in combination. The provider answers yes or no based on the exam and treatment records.

Does the breast DBQ cover cancer treatment?

Yes. Section II asks about any benign or malignant breast neoplasm, and Section III asks whether treatment is completed, ongoing or in watchful waiting, and which types apply: surgery, radiation therapy, antineoplastic chemotherapy or other procedures, with dates. Residuals of the cancer or its treatment are listed separately.