Veterans claiming one of the infectious diseases on VA's Persian Gulf and Afghanistan list use this 6-page questionnaire. The listed diseases are brucellosis, Campylobacter jejuni, Q fever, malaria, nontyphoid salmonella, shigella, visceral leishmaniasis and West Nile virus. For each, the clinician records the history, whether it is active or resolved and when treatment stopped, any residuals, and how the diagnosis or relapse was confirmed.
The Veteran's treating or examining clinician completes the form and signs the Section X examiner's certification. The Veteran fills in no part of it.
Download the current version from the source each time; forms change without notice.
Persian Gulf and/or Afghanistan Infectious Diseases (Other Than Tuberculosis) 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.
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Brucellosis, Campylobacter jejuni, Coxiella burnetii (Q fever), malaria, nontyphoid salmonella, shigella, visceral leishmaniasis and West Nile virus. Mycobacterium tuberculosis also appears in the list, but it is documented on the separate Tuberculosis DBQ. Other diseases can be described in Section V.
For VA purposes a relapse is a full return of a disease or its signs and symptoms after a period of improvement, while a recurrence is a separate episode after full recovery. VA requires diagnostic confirmation of the initial diagnosis and of any relapse or recurrence.