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VA Urinary Tract Conditions DBQ (Bladder, Urethra)

Veterans claiming a bladder or urethra condition can have their own clinician document it on this public questionnaire. It records voiding dysfunction in the terms VA rates, such as absorbent pad changes per day, daytime voiding interval and nighttime awakenings, plus catheter use, stones, recurrent infections, fistulas, neoplasms and test results. The male reproductive system is excluded.

Who completes it

The Veteran's treating or examining clinician completes all sections and signs the Section XII certification with NPI, license and specialty. The Veteran has no section of their own.

Submitting and payment

How to submit it
The clinician gives the signed form to the Veteran, who uploads it with the claim on VA.gov or mails it to the VA Evidence Intake Center; a representative may also submit it.
Who pays
VA will not pay or reimburse any cost of completing the questionnaire; any fee is between the Veteran and the clinician.

Good to know

  • Leakage is described as not requiring absorbent material, or requiring material changed fewer than 2, 2 to 4, or more than 4 times a day.
  • Frequency is recorded as a daytime voiding interval (under 1 hour, 1 to 2, or 2 to 3 hours) and nighttime awakenings to void (2, 3 to 4, or 5 or more).
  • Urinary retention is noted as requiring intermittent or continuous catheterization, and obstructed voiding by hesitancy, slow or weak stream and decreased force.
  • Renal dysfunction counts only if shown for at least 3 consecutive months in the past 12, and then the kidney questionnaire is also needed. Current version July 16, 2024 (v24_1).

Get the official form

Download the current version from the source each time; forms change without notice.

Urinary Tract (Including Bladder and Urethra) Conditions (Excluding Male Reproductive System) Disability Benefits Questionnaire

Official pagePDF

How this list is checked

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.

Frequently asked questions

Does the urinary tract DBQ cover male reproductive conditions?

No. The title excludes the male reproductive system, and VA has a separate male reproductive organ questionnaire that other DBQs refer to. This form covers the bladder and urethra: voiding dysfunction, bladder and urethral stones, recurrent infections, fistulas, diverticulum, neurogenic bladder, bladder injury and related neoplasms.

How should incontinence be documented on the VA urinary DBQ?

Item 3C asks whether voiding dysfunction causes leakage and, if so, how often absorbent material must be changed: fewer than 2 times, 2 to 4 times, or more than 4 times a day. Item 3D asks whether an appliance is needed and asks the examiner to describe it.

Who can complete the urinary tract DBQ?

The Veteran's own treating or examining clinician, such as an MD, DO, NP or PA, completes and signs it with NPI and license details. VA may verify the questionnaire's authenticity and can still order its own examination.