Veterans claiming a wrist condition can have their own clinician complete this 13-page public questionnaire. It lists wrist diagnoses by side, from chronic sprain and TFCC injury to carpal instability and arthritis, then records range of motion for both wrists, pain, repetitive-use and flare-up losses, atrophy, ankylosis, surgery, assistive devices and imaging. VA uses it to decide service connection and assign a rating.
The Veteran's treating or examining clinician completes all sections and signs the Section XIII certification with NPI, license and specialty. The Veteran does not complete any part.
Download the current version from the source each time; forms change without notice.
Wrist Conditions 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. Section III has columns for the right and left wrist, and VA asks examiners to test the opposite joint unless it is medically contraindicated. If the unclaimed wrist is undamaged, range of motion testing must still be done, and any reason testing could not be performed must be explained.
Not for every condition. Degenerative or post-traumatic arthritis must be confirmed by imaging, but once it has been documented, even in the past, VA does not require new imaging, even if the arthritis has worsened. Item 10D covers any other relevant test results.
No. The form states that VA will not pay or reimburse any expense of completing or submitting it. The fee, if any, is between the Veteran and the clinician, and VA may still order its own examination.