Veterans claiming service connection for tuberculosis, including latent infection or a positive screening test, can have their own clinician complete this public questionnaire. It covers diagnosis, treatment and medications, pulmonary and non-pulmonary TB, residuals such as thoracoplasty, scars, imaging and pulmonary function testing. VA uses it to decide service connection and assign a rating.
The Veteran's treating or examining clinician (MD, DO, NP, PA or other licensed provider) completes all sections and signs the Section IX certification with NPI, license and specialty. The Veteran does not fill in any part.
Download the current version from the source each time; forms change without notice.
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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Yes. Items 1B and 1C ask whether the Veteran has had a positive skin test or a positive QuantiFERON-TB Gold test without active disease, and item 2B asks about treatment for those findings as well as for active TB. Item 2C lists the medications used, current or past.
Not always. The form says PFTs are not required in all instances, but if they were not done the examiner gives the reason. When performed, it records FEV-1, FVC, FEV-1/FVC and DLCO and asks which result best reflects current function. Results already in the record that reflect the current condition need not be repeated.
No. The form states that VA will not pay or reimburse any expense of completing or submitting it. The Veteran and the clinician arrange any fee, and VA may still order its own exam after reviewing the questionnaire.