Veterans claiming a knee or lower leg condition, from strain and meniscal or ligament tears to osteoarthritis, patellar instability, tibia fractures and shin splints, use this public questionnaire to submit a clinician's findings. The 14-page form, updated July 31, 2026, records right and left knees side by side: range of motion, repetitive use and flare-ups, atrophy, ankylosis, stability, tibial or fibular impairment, meniscal conditions and surgery.
The Veteran's treating or examining clinician (MD, DO, NP, PA or other licensed clinician) completes all 16 sections and signs the Section 16 certification with NPI, license and specialty. The Veteran describes flare-ups, instability and functional loss in their own words for the clinician to record.
After noting who requested the DBQ, whether the exam was in person and which records were reviewed, list the claimed conditions in 1A. In 1B, check diagnoses by side with ICD code and date, such as knee strain, meniscal tear, ACL or PCL tear, tendon rupture, osteoarthritis, ankylosis, fractures, recurrent patellar dislocation or subluxation, knee or patellar instability, cartilage restoration surgery, shin splints, patellofemoral pain syndrome, arthritis types and inflammatory conditions. Explain a missing or changed diagnosis in Remarks.
Item 2A summarizes onset and course. Item 2B records flare-ups with frequency, duration, triggers, relieving factors and severity, and 2C any functional loss, including after repeated use, in the Veteran's own words. Items 2D and 2E ask about reported or documented instability or recurrent subluxation, and frequent effusion, including whether the effusion results from a Section 1 diagnosis.
For each knee, record whether initial ROM is normal, abnormal, unable to test or not indicated, and whether abnormal motion itself causes functional loss. Measure active and passive flexion and extension in degrees, mark painful motions and degrees lost to pain, weakness, fatigability or incoordination. Note whether an unclaimed knee is damaged or undamaged. Then report pain on weight-bearing, non-weight bearing, motion or rest, crepitus, and localized tenderness with location and severity.
Perform at least three repetitions on each knee and record any added loss of flexion or extension and its causes. For repeated use over time and for flare-ups, state whether the exam coincides with either, whether the Veteran's statements suggest significant limitation, and estimate endpoints in degrees with cited evidence. Item 3E lists other contributing factors, such as interference with sitting or standing, swelling, deformity, instability of station, and more movement than normal, indicating any nonunion of fracture.
Record whether muscle atrophy is present and due to the claimed condition, with a rationale if not, and give circumferences of the more normal and atrophied sides in centimeters at a stated location, such as 10 cm above or below the knee. For ankylosis, choose the angle category, from favorable at 0 to 10 degrees of flexion to extremely unfavorable at 45 degrees or more, enter the angle, and note any Muscle Group XIII involvement.
For each knee, record recurrent subluxation or persistent instability, any complete or partial ligament tear, and whether a complete tear repair succeeded or failed. Item 6D asks whether a provider has prescribed a cane, walker, crutches or brace for ambulation. Items 6E to 6G repeat the questions for recurrent patellar instability, including surgical repair; under the form's note, procedures that don't repair a patellofemoral component don't count.
Item 7A covers stress fractures of the lower leg, acquired or traumatic genu recurvatum with objectively shown weakness and insecurity in weight-bearing, recurrent patellar dislocation, and leg length discrepancy measured from the anterior superior iliac spine to the internal malleolus. Item 7B covers shin splints, treatment length and response. Section 8 records meniscal conditions: no current symptoms, dislocation, tear, or frequent locking, pain or effusion, with a description.
Check each procedure by knee with its date: total knee replacement, with residuals graded as none, intermediate weakness, pain or limitation of motion, chronic severe painful motion or weakness, or other; knee joint resurfacing; meniscectomy; arthroscopic ligament repair; or other surgery by type. For any procedure other than total knee replacement, state whether residual signs or symptoms remain and describe them.
Record other findings and scars, which also need the dermatological questionnaire, and assistive devices not already noted in Section 6, with frequency of use. State whether either leg's function is so diminished that an amputation with prosthesis would serve equally well. Report imaging and arthritis by side, other test results, and work impact of the diagnosed conditions alone. The examiner signs Section 16 with title, specialty, date, NPI, license number and state, and address.
Download the current version from the source each time; forms change without notice.
Knee and Lower Leg Disability Benefits Questionnaire
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.
Sources for this guide
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Yes, in most cases. The form tells examiners to test the contralateral joint unless medically contraindicated, and each knee has its own column for range of motion, pain, repetitive use and flare-ups. If the unclaimed knee is undamaged, range of motion testing must be done; if testing can't be performed, the examiner explains why.
Item 7B asks whether the Veteran has or has had shin splints (medial tibial stress syndrome) and whether there is pain with motion at the tibia beyond the pain reported earlier. The examiner then records length of treatment, none, under 12 consecutive months, or 12 months or more, and whether it responded to treatment, orthotics or surgery.
Not for every condition. Degenerative or post-traumatic arthritis must be confirmed by imaging, but once documented, even in the past, VA requires no further imaging even if it has worsened. Item 13A asks whether clinically relevant imaging or other diagnostic procedures were performed or reviewed for this exam, and 13B whether arthritis is documented, by side.
Item 3D asks for flexion and extension estimates in degrees during flare-ups, based on all procurable information: the Veteran's statements, treatment records, lay evidence and the examiner's expertise, with that evidence cited. If an estimate isn't feasible, the examiner explains why, and the explanation cannot rest on a general aversion to estimating.