VA publishes this 9-page questionnaire so a Veteran's own clinician can document the current severity of PTSD that is already service connected, for a review or a claim for an increase. It records current diagnoses, the DSM-5 criteria met, the level of occupational and social impairment, rating symptoms and financial competency. VA treats it as evidence and may still schedule its own examination.
A board-certified or board-eligible psychiatrist or a licensed doctorate-level psychologist completes the whole form. Trainees, an LCSW, or an NP, CNS or PA privileged by VHA may complete it only under close supervision with the supervisor's co-signature; there is no section for the Veteran.
Record who asked for the DBQ (Veteran or claimant, third party or other), whether you are a VA provider, whether the Veteran is regularly seen in your clinic, and whether the exam was in person, describing the method if not. The notes state that the evaluation is for disability purposes, not treatment, and rests on DSM-5 criteria. They also list the seven types of examiner allowed to conduct a review PTSD exam and define close supervision.
Item 1, based on the current examination and findings, asks whether the Veteran now has or has ever been diagnosed with PTSD, with the ICD code. Item 2A lists current mental disorder diagnoses, up to four with ICD codes and comments, plus any more in the same format. Item 2B covers medical diagnoses relevant to understanding or managing the mental health disorder, including TBI.
3A and 3B ask whether more than one mental disorder is diagnosed and whether symptoms can be attributed to each, with a reason if not and any clinical association between the diagnoses. 3C and 3D repeat this for TBI. 4A asks for the one statement that best summarizes occupational and social impairment from all mental diagnoses; check only one. 4B and 4C ask whether that impairment can be divided by disorder and by TBI.
Check whether records were reviewed and, if so, identify them, such as service, VA or private treatment records, with the date range. Items 2A to 2F ask only for history since the prior exam: social, marital and family; occupational and educational; mental health, including prescribed medications and family mental health; legal and behavioral; substance abuse; and anything else relevant.
Check the DSM-5 criteria used to establish the current diagnosis: A (traumatic exposure), B (intrusion symptoms), C (avoidance), D (negative alterations in cognition and mood), E (alterations in arousal and reactivity), F (duration over one month), G (clinically significant distress or impairment) and H (not due to a substance or another medical condition). Each block has a not-met option. Do not mark symptoms clearly unrelated to the Criterion A stressor; list overlapping ones under Other Symptoms.
Item 4 is the checklist of symptoms for VA rating purposes, from depressed mood, anxiety and chronic sleep impairment to suicidal ideation, persistent delusions or hallucinations and intermittent inability to perform activities of daily living. Check all that apply to the Veteran's diagnoses. Item 5 is free text for behavioral observations, and item 6 asks for any other symptoms attributable to PTSD or other mental disorders that the checklist does not include.
Item 7 asks whether the Veteran is capable of managing his or her financial affairs, using VA's definition of a mentally incompetent person: 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. A No answer needs each responsible injury or disease and a supporting rationale. Item 8 holds remarks, including any testing results.
The examiner certifies that the information is accurate, complete and current, beneath a penalty statement covering willful false statements. Complete 3A to 3H: signature, printed name and title, area of practice or specialty, date signed, phone and fax, National Provider Identifier, medical license number and state, and address. When a supervised clinician performs the exam, the supervising psychiatrist or psychologist co-signs the report.
Download the current version from the source each time; forms change without notice.
Review Post Traumatic Stress Disorder (PTSD) 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.
Only within the limits printed on the form. A psychiatrist or licensed doctorate-level psychologist can complete it alone. A licensed clinical social worker may do so only under close supervision, and an NP, CNS or PA only under close supervision and with VHA clinical privileges for these exams. The supervisor must meet the Veteran, confer on the diagnosis and co-sign.
VA does not publish it. The public DBQ page lists Initial Post Traumatic Stress Disorder (PTSD) among questionnaires not available for public use, citing limits in federal regulations or specialized training. The Mental Disorders DBQ likewise says a Veteran with PTSD needs the initial questionnaire completed by a VHA staff or contract examiner.
Criteria A to H: exposure to actual or threatened death, serious injury or sexual violation; intrusion symptoms; avoidance; negative alterations in cognition and mood; alterations in arousal and reactivity; duration of more than one month; clinically significant distress or impairment; and a disturbance not due to a substance or medical condition. Check the criteria used for the current diagnosis.
No. The first lines of the form state that VA will not pay or reimburse any expense of completing or submitting it, so the Veteran arranges any fee with the provider. VA may also obtain more information, including its own examination, and if an exam is scheduled the Veteran must attend.