Veterans claiming epilepsy or another seizure disorder for VA compensation use this 7-page questionnaire. The clinician selects the seizure type, from tonic-clonic and absence seizures to Jacksonian, focal, diencephalic and psychomotor epilepsy, confirms the diagnosis and any witnessed seizure, and then counts major and minor seizures over the past 2 years and 6 months with their average frequency. Seizure frequency is the core of the form.
The Veteran's treating or examining clinician completes the form and signs the Section IX examiner's certification. Witnesses to seizures are described by the examiner, including their relationship to the Veteran.
Download the current version from the source each time; forms change without notice.
Seizure Disorders (Epilepsy) 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.
Item 2E asks whether the Veteran has had a witnessed seizure and, if so, to describe it, including the witnesses' relationship to the Veteran. Separate items ask whether the diagnosis has been confirmed and whether there is a confirmed diagnosis of epilepsy with a history of seizures.
Section VI lists MRI, CT, cerebrospinal fluid examination, EEG and neuropsychologic testing, each with date and results. Results in the medical record that reflect the current seizure disorder do not need to be repeated.