Abdominal adhesions from surgery, trauma, infection or inflammatory disease such as chronic cholecystitis or Crohn's disease are documented for VA disability claims on this 4-page questionnaire. The clinician names the cause and the organs involved, marks the adhesions asymptomatic or symptomatic, and records diarrhea, constipation, colic, vomiting, pain, dietary modification and any persistent partial bowel obstruction, plus hospitalizations for adhesions in the past 24 months.
The Veteran's treating or examining clinician completes the form and signs the Section IX examiner's certification. The Veteran completes no part of the form.
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Peritoneal Adhesions Disability Benefits Questionnaire
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When a Veteran claims adhesions in the abdomen caused by surgery, trauma, an inflammatory process such as chronic cholecystitis or Crohn's disease, or infection. It is often completed alongside the Intestinal Conditions DBQ, which directs examiners here when adhesions follow intestinal surgery.
Item 3B lists diarrhea, constipation, colic, vomiting, nausea, abdominal pain, medically directed dietary changes other than TPN, persistent partial bowel obstruction, and recurrent obstructions requiring hospitalization at least once a year as documented in the health record.