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VA Male Reproductive Organ DBQ (Prostate Cancer)

Erectile dysfunction, prostate cancer, prostatitis, prostate hypertrophy and postoperative residuals, testicular atrophy or removal, epididymitis, orchitis and varicocele are documented for VA disability claims on this 9-page questionnaire. The clinician records voiding dysfunction in detail, including absorbent pad changes, appliances, daytime and nighttime frequency and obstructive symptoms, plus infections, a genital and prostate exam, and cancer treatment such as surgery, radiation, brachytherapy or androgen deprivation.

Who completes it

The Veteran's treating or examining clinician completes the form and signs the Section 13 examiner's certification. The Veteran fills in nothing on the form.

Submitting and payment

How to submit it
The Veteran receives the signed DBQ and uploads it with the claim on VA.gov or mails it to the VA Evidence Intake Center; a representative may file it for them.
Who pays
VA will not pay or reimburse any cost of completing this DBQ; any fee is arranged between the Veteran and the provider.

Good to know

  • Urine leakage is graded by absorbent material changes per day: none, fewer than 2, 2 to 4, or more than 4, or by need for an appliance.
  • The exam allows each part to be marked not examined at the Veteran's request, and the prostate exam may be skipped when not medically advisable, such as after recent surgery or seed implants.
  • Renal dysfunction from a reproductive condition, defined by GFR and urine findings over 3 consecutive months, requires the appropriate genitourinary questionnaire as well.
  • Cancer treatment options include TURP, radiation, brachytherapy, chemotherapy and androgen deprivation therapy, each with dates of completion or anticipated completion.

Get the official form

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

Male Reproductive Organ Conditions (Including Prostate Cancer) 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

Is erectile dysfunction claimed on the male reproductive DBQ?

Yes. Erectile dysfunction, with or without penile deformity, is the first listed diagnosis, and Section 4 asks whether ED is present and its etiology if known. Retrograde ejaculation is covered separately in Section 5, also with etiology.

How does this DBQ document prostate cancer residuals?

Section 8 records whether the neoplasm is active or in remission, treatment completed or under way (surgery, TURP, radiation, brachytherapy, chemotherapy or hormonal therapy) with dates, and any residuals. Voiding dysfunction after treatment is graded in Section 3 by pad changes, frequency and obstructive symptoms.

Can the Veteran decline the genital exam on this DBQ?

Yes. For the penis, testes, epididymis and prostate the examiner can mark not examined per the Veteran's request, including a version where the Veteran reports normal anatomy, or not examined because the exam is not relevant to the condition.