Loss of smell or taste claimed for VA disability, whether anosmia, hyposmia, ageusia or hypogeusia, is documented on this short 5-page questionnaire. The clinician records the history, whether loss of smell and of taste is partial or complete, and whether there is a known anatomical or pathological basis, then lists any MRI, CT or qualitative smell and taste testing. The form asks these questions for each sense separately.
The Veteran's treating or examining clinician completes the form and signs the Section VIII examiner's certification. The Veteran completes no part of it.
Download the current version from the source each time; forms change without notice.
Loss of Sense of Smell and/or Taste 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.
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No. The form states that specific diagnostic testing is not required for a loss of smell and taste examination. If qualitative smell or taste testing was done, item 5B records the test type, date and results, and item 5A covers MRI, CT or other imaging.
Anosmia (inability to detect any odor), hyposmia (reduced ability to detect odors), ageusia (complete lack of taste) and hypogeusia (decreased taste), each with an ICD code and date of diagnosis, plus space for other related diagnoses.