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VA Chronic Fatigue Syndrome DBQ (CFS Disability Form)

Veterans claiming chronic fatigue syndrome for VA disability compensation can ask their own clinician to complete this 5-page public questionnaire. It records the diagnosis against VA's CFS criteria, the history and medications, the signs and cognitive symptoms, and either how far daily activity is restricted or how many weeks a year are incapacitating. VA weighs it as evidence when it decides service connection and the rating.

Who completes it

The Veteran's treating or examining clinician (MD, DO, NP, PA or other licensed provider) completes every item and signs the Section VIII certification with NPI, license number and state, and specialty. The Veteran has no section of their own but provides the history behind items 2A to 2E.

Submitting and payment

How to submit it
The clinician hands the signed DBQ to the Veteran, who uploads it with the claim on VA.gov or mails it to the VA Evidence Intake Center; a representative can also submit it. VA's DBQ page asks that the filled form be printed to PDF before upload.
Who pays
VA does not pay or reimburse any cost of completing or submitting the CFS DBQ, so any fee is arranged between the Veteran and the provider.

Good to know

  • The form prints VA's CFS definition: new debilitating fatigue cutting daily activity below 50 percent for at least 6 months, other causes excluded, and six or more of ten listed criteria.
  • For VA purposes CFS is incapacitating only while it requires bed rest and treatment by a physician, which governs the weeks-per-year answer in item 3E.
  • Item 3C branches the form: nearly constant symptoms go to 3D, which grades restriction against the pre-illness activity level, while symptoms that wax and wane skip to the incapacitation question.
  • Scars related to CFS or its treatment need the separate dermatological DBQ, and existing test results that reflect the current condition do not have to be repeated.

Get the official form

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

Chronic Fatigue Syndrome (CFS) 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

Who can fill out the VA chronic fatigue syndrome DBQ?

Any licensed clinician who treats or examines the Veteran, such as an MD, DO, NP or PA, can complete it. Every certification field must be filled in, including NPI, license number and state, specialty and contact details, because VA reserves the right to confirm the authenticity of every DBQ it receives.

Does VA still order its own exam after a CFS DBQ is submitted?

It can. The form states that VA may obtain additional medical information, including an examination, to complete its review of the claim. VA's DBQ page adds that a Veteran who is scheduled for an exam must report for it, and that in most cases the VA exam costs the Veteran nothing.

Does the CFS DBQ have a VA form number?

No. Current public DBQs print no VA form number; they were formerly issued in the VA Form 21-0960 series. The version on VA's site is dated 2024-08-02. The claim itself is filed separately, typically on VA Form 21-526EZ, with VA Forms 21-4142 and 21-4142a used to release private records.