Veterans claiming multiple sclerosis for VA compensation use this 13-page questionnaire to document how MS affects each body system. Beyond the neurologic exam of gait, strength, reflexes and sensation, it records swallowing, respiratory, sleep, bowel, bladder, vision and sexual effects, then asks whether the Veteran is housebound, needs aid and attendance or skilled care, uses assistive devices, and can manage benefit payments. VA weighs these answers when it rates the condition.
The Veteran's treating or examining clinician completes all sections and signs the Section XVI examiner's certification. The Veteran completes no part of the form.
Download the current version from the source each time; forms change without notice.
Multiple Sclerosis (MS) 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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Yes. Section VIII asks whether, because of MS, the Veteran can dress, feed, toilet, bathe and stay presentable without help, take medications accurately, and protect themselves from daily hazards, and whether they are bedridden or legally blind. Section IX asks whether a higher, skilled level of care is needed.
Not if results in the record reflect current respiratory function. The form adds that DLCO and bronchodilator testing are not indicated for a restrictive respiratory disability caused by MS-related muscle weakness. FEV1, FVC and FEV1/FVC go in Section XIII with test dates.