Irritable bowel syndrome, Crohn's disease, ulcerative colitis, diverticular disease, celiac disease, bowel resections, bariatric surgery complications and intestinal fistulas are documented for VA disability claims on this 11-page questionnaire. Each diagnosis checked in Section I points the clinician to the sections to complete, which capture defecation-related pain frequency, treatment level, hospitalizations, diarrhea episodes, nutrition support, and endoscopy, imaging and lab results.
The Veteran's treating or examining clinician completes the sections that match each diagnosis and signs the Section XIX examiner's certification. The Veteran fills in no part of the form.
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Intestinal Conditions Disability Benefits Questionnaire
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Yes. Irritable bowel syndrome is the first listed diagnosis and is documented in Section III with the frequency of defecation-related abdominal pain over the previous 3 months and signs such as changes in stool frequency or form, straining or urgency, bloating, distention and mucorrhea.
Section VIII covers small intestine resection, short bowel syndrome, mesenteric ischemia and celiac malabsorption, with diarrhea episodes, undernutrition, anemia and supplementation or TPN needs. Section IX covers large intestine resection, including partial or total colectomy, permanent colostomy, loss of the ileocecal valve and dehydration needing IV fluids.
Section V asks whether diverticular disease is asymptomatic, managed by diet and medication, or required hospitalization in the past 12 months, with dates and reasons such as abdominal distress, fever or leukocytosis, and complications including hemorrhage, obstruction, abscess or peritonitis.