Back And Neck DBQ: Official VA Form

The two public back and neck forms record different spinal regions. Each official form is provided separately below. The public Back And Neck Disability Benefits Questionnaire records medical information for VA evaluation. The form itself provides its current questions, definitions, examination and clinician requirements. A completed form is evidence; it does not establish service connection or guarantee an evaluation.

Related Diagnostic Code Subjects

18 code subjects are associated with this form in this educational directory. These editorial subject associations are not official VA assignments, and the form may not be appropriate for every examination or claim.

• DC 5235: Vertebral fracture or dislocation
• DC 5236: Sacroiliac injury and weakness
• DC 5237: Lumbosacral or cervical strain
• DC 5238: Spinal stenosis
• DC 5239: Spondylolisthesis or segmental instability
• DC 5240: Ankylosing spondylitis
• DC 5241: Spinal fusion
• DC 5242: Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome (also, see either DC 5003 or 5010)
• DC 5243: Intervertebral disc syndrome: Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign diagnostic code 5242 for all other disc diagnoses
• DC 5235: Vertebral fracture or dislocation
• DC 5236: Sacroiliac injury and weakness
• DC 5237: Lumbosacral or cervical strain
• DC 5238: Spinal stenosis
• DC 5239: Spondylolisthesis or segmental instability
• DC 5240: Ankylosing spondylitis
• DC 5241: Spinal fusion
• DC 5242: Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome (also, see either DC 5003 or 5010)
• DC 5243: Intervertebral disc syndrome: Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign diagnostic code 5242 for all other disc diagnoses

Read The Form Before Arranging An Examination

Review who may complete the form, which conditions it includes or excludes, and whether testing is required. VA can still request a claim examination. Report actual findings; this reference does not provide suggested answers.

Read The Claim Examination Guide · Return To The Rating Schedule