Veterans use this 8-page questionnaire to give VA a clinician's DSM-5 findings on a claimed mental health condition other than PTSD or an eating disorder. The examiner records diagnoses, the level of occupational and social impairment, symptoms for rating purposes and financial competency. VA weighs it as claim evidence to decide service connection and the rating, and may still order its own examination.
Initial exams must be done by a board-certified or board-eligible psychiatrist or a licensed doctorate-level psychologist, or by certain trainees under close supervision. Review exams may also be done under close supervision by an LCSW, or by an NP, CNS or PA privileged by VHA for these exams; the Veteran has no section to complete.
Before Section 1 the examiner answers who requested the DBQ (Veteran or claimant, a named third party, or other), whether you are a VA health care provider, whether the Veteran is regularly seen in your clinic, and whether the Veteran was examined in person, describing the method if not. The notes on this page also set who may conduct initial and review exams and state that the evaluation rests on DSM-5 criteria and is for disability evaluation, not treatment.
A1 asks whether the Veteran now has, or has ever been diagnosed with, a mental disorder. List each current diagnosis that conforms to DSM-5 criteria with its ICD code and any comments; there is room for three, and more can be added in the same format. A2 captures medical diagnoses relevant to understanding or managing the mental disorder, including TBI. If the diagnosis is PTSD or an eating disorder, stop and use the questionnaire the form names instead.
When more than one mental disorder is diagnosed, B2 asks whether symptoms can be attributed to each diagnosis, with a reason if not and any clinical association between them. B3 and B4 do the same for TBI versus non-TBI diagnoses. C1 asks for the single statement that best summarizes occupational and social impairment from all mental diagnoses, from no diagnosis to total impairment; check only one. C2 and C3 ask whether that impairment can be split by disorder and by TBI.
Item 1 records the evidence review: check whether records were reviewed and identify them with the date range. Items 2A to 2F cover social, marital and family history; occupational and educational history; mental health history, including prescribed medications and family mental health; legal and behavioral history; substance abuse history; and anything else relevant. An initial exam needs pre-military, military and post-military history, while a review exam covers only what is relevant since the prior exam.
3A is a checklist of symptoms for VA rating purposes; check every one that applies to the Veteran's diagnoses. It runs from depressed mood, anxiety, suspiciousness and chronic sleep impairment through panic attacks (weekly or less often, or more than once a week), memory loss of increasing severity, impaired judgment, suicidal ideation, impaired impulse control, persistent delusions or hallucinations, neglect of personal appearance and hygiene, and disorientation to time or place.
4A is a free-text box for the examiner's behavioral observations during the interview. 5A asks whether the Veteran has other symptoms attributable to a mental disorder that the Section 3 checklist does not include; if yes, describe them. If the Veteran has a mental health emergency during the interview, the form tells the examiner to stop and obtain help through local resources or the Veterans Crisis Line.
6A asks whether the Veteran is capable of managing his or her financial affairs. The note gives VA's definition: a mentally incompetent person is one who, because of injury or disease, lacks the mental capacity to contract or to manage his or her own affairs, including disbursement of funds without limitation. If you answer No, name each injury or disease resulting in incompetency and give a rationale supporting the finding.
7A holds remarks, including any testing results. In Section 8 the examiner certifies that the information is accurate, complete and current, beneath a penalty statement for willful false statements. Complete 8A to 8H: signature, printed name and title, area of practice or specialty, date signed, phone and fax, NPI, medical license number and state, and address. When the exam was done under close supervision, the supervising psychiatrist or psychologist must also co-sign.
Download the current version from the source each time; forms change without notice.
Mental Disorders (Other Than PTSD and Eating Disorders) 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
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
For an initial exam: a board-certified or board-eligible psychiatrist, a licensed doctorate-level psychologist, or, under close supervision, an unlicensed doctorate-level psychologist working toward licensure, a psychiatry resident or a VHA psychology trainee. Review exams can also be done under close supervision by an LCSW, or by an NP, CNS or PA clinically privileged by VHA for these examinations.
No. The form directs that when the Veteran has a PTSD diagnosis, the Initial PTSD questionnaire must be completed by a VHA staff or contract examiner instead, and VA lists that questionnaire as not available for public use. For PTSD that is already service connected, VA publishes a separate Review PTSD DBQ that private clinicians can complete.
Not necessarily. The evidence review item lets the examiner check either No records were reviewed or Records reviewed. When records were reviewed, identify them, such as service treatment records, VA treatment records or private treatment records, and give the date range so VA can see what the findings are based on.
No. The form and VA's public DBQ page both state that VA will not pay or reimburse any expense of completing or submitting it. The Veteran and provider settle any fee between themselves, and VA notes that in most instances a Veteran is entitled to a VA disability examination at no cost.