Veterans claiming osteomyelitis for VA compensation use this 7-page questionnaire to document the infection's history and current activity. The clinician records where the initial infection occurred, from pelvis and vertebrae to long bones, fingers and toes, medical and surgical treatment with dates, whether the condition is active, inactive or resolved, the number and dates of recurrences, and findings such as involucrum, sequestrum, a discharging sinus or amyloidosis.
The Veteran's treating or examining clinician completes the form, including the dominant hand, and signs the Section XII examiner's certification. The Veteran does not complete any section.
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Osteomyelitis Disability Benefits Questionnaire
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Item 4A lists involucrum, sequestrum, a discharging sinus, amyloidosis secondary to chronic infection, anemia, other constitutional symptoms, and decreased joint function or range of motion. Item 4B covers symptoms such as pain, swelling, tenderness, erythema, warmth and malaise, each described by the examiner.
Yes, along with the Oral and Dental DBQ. The dental questionnaire directs examiners to complete the Osteomyelitis questionnaire for osteomyelitis or osteoradionecrosis of the mandible, so both forms document the jaw infection and any tooth or bone loss it caused.