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VA Eye Conditions DBQ (Vision Disability Form)

Any eye condition a Veteran claims, other than congenital or developmental refractive error, is documented on this 14-page VA questionnaire. It walks through a full eye exam: corrected and uncorrected acuity, pupils, diplopia fields, tonometry, slit lamp and fundus, visual fields, then condition modules for eyelids, dry eye, cornea, glaucoma, uvea, cataract, retina, neuro-ophthalmic disorders, neoplasms and trauma. VA rates vision loss and incapacitating episodes from these results.

Who completes it

An eye care examiner completes the whole form and signs the Section 9 certification; VA's Diabetes Mellitus DBQ states that the Eye questionnaire must be completed by an ophthalmologist or optometrist. The Veteran completes no part of it.

Submitting and payment

How to submit it
The examiner gives 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 may submit it too.
Who pays
VA does not pay or reimburse any cost of completing the eye DBQ; any exam or form fee is between the Veteran and the eye care provider.

Good to know

  • Acuity falling between two Snellen lines is rounded to the worse line (20/60 is reported as 20/70), and rating uses corrected distance vision with central fixation.
  • Visual field testing must use Goldmann kinetic perimetry or Humphrey Model 750, Octopus Model 101 or later devices with simulated kinetic Goldmann testing, documented for at least 16 meridians per eye.
  • Under 38 CFR 4.79, an incapacitating episode is an eye condition needing a clinic visit specifically for treatment, such as injections, laser, surgery or immunosuppressants; Section 6 counts documented visits.
  • The form says to complete the diagnosis section only after the examination is finished, and to list each diagnosis with an ICD code.

Get the official form

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

Eye Conditions 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

Can an optometrist complete the VA Eye Conditions DBQ?

Yes. VA's Diabetes Mellitus DBQ specifies that the Eye questionnaire must be completed by an ophthalmologist or optometrist. The examiner signs the Section 9 certification with NPI, license number and state, and specialty, and VA may verify authenticity or order its own exam.

How is diplopia documented on the eye DBQ?

The examiner records the cause, maps where double vision occurs using a Goldmann perimeter chart or tangent screen (central 20 degrees, 21 to 30, 31 to 40 and beyond 40, up, down and lateral), notes whether it is constant or occasional, and states whether standard or prismatic spectacles correct it.

Does dry eye after LASIK go on this form?

Yes. The lacrimal system module asks which eye has dry eye syndrome, when it began, whether the Veteran had an elective procedure such as LASIK and whether dry eye began after it, the treatments used (from artificial tears to punctal plugs or surgery), and whether it reduces visual acuity.