Yes! You can use AI to fill out Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire

The Back (Thoracolumbar Spine) Conditions DBQ is a standardized U.S. Department of Veterans Affairs medical form completed by a qualified healthcare provider to report clinical findings related to thoracolumbar spine conditions. It captures diagnoses, medical history, range-of-motion testing (including pain and functional loss), radiculopathy/neurologic findings, IVDS/bed-rest history, imaging, and occupational impact. VA uses this information as medical evidence to help determine service connection and assign a disability rating. Accurate, complete provider documentation is important because it can reduce delays and may lessen the need for an additional VA Compensation & Pension (C&P) exam.
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Form specifications

Form name: Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire
Number of pages: 13
Language: English
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How to Fill Out VA DBQ Back (Thoracolumbar Spine) Online for Free in 2026

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Follow these steps to fill out your VA DBQ BACK (THORACOLUMBAR SPINE) form online using Instafill.ai:
  1. 1 Enter Veteran/patient identifiers and exam details (name, SSN, date of examination) and indicate who requested the DBQ and whether the examiner is a VA provider.
  2. 2 Complete the Evidence Review section by listing which records were reviewed (service, VA, private) and the applicable date ranges.
  3. 3 Fill Section I (Diagnosis) by listing claimed conditions, selecting the applicable thoracolumbar diagnoses, and providing ICD codes and diagnosis dates as available.
  4. 4 Complete Sections II–III by documenting medical history, flare-ups, functional loss, and performing/recording thoracolumbar ROM testing (active/passive, weight-bearing/non-weight-bearing), repetitive-use results, and estimated ROM during repeated use and flare-ups with supporting rationale.
  5. 5 Complete Sections IV–X by recording muscle strength, atrophy, reflexes, sensory testing, straight leg raise results, radiculopathy details (symptoms, nerve roots, severity), ankylosis status, and any other neurologic abnormalities.
  6. 6 Complete Sections XI–XVI by addressing IVDS and physician-prescribed bed rest, assistive devices, remaining effective function of extremities, other findings/scars, diagnostic testing/imaging results, and the functional/occupational impact.
  7. 7 Review for completeness, add any needed remarks, and finalize Section XVIII with examiner certification, signature, credentials, specialty, contact information, NPI, medical license/state, address, and date signed before generating the final submission-ready document.

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Frequently Asked Questions About Form VA DBQ Back (Thoracolumbar Spine)

This DBQ documents a Veteran’s thoracolumbar spine (mid/low back) condition and related symptoms so VA can evaluate a disability claim. VA uses the medical findings (diagnoses, range of motion, functional impact, and neurologic issues like radiculopathy) as evidence when deciding the claim.

It is intended to be completed by the Veteran’s healthcare provider (examiner), not the Veteran. The examiner must certify and sign the form and include credentials, license information, and contact details.

No. The form states VA will not pay or reimburse any expenses or costs incurred to complete and/or submit the DBQ.

The form asks whether the Veteran was examined in person, and if not, how the exam was conducted. If telehealth is used, the examiner should clearly document the method and ensure required measurements (like range of motion) can be supported; otherwise they must explain why testing could not be performed.

In the Evidence Review section, the examiner indicates whether records were reviewed and lists what was reviewed (e.g., service treatment records, VA records, private records) and the date range. If no records were reviewed, that must be checked and documented.

Section I includes common thoracolumbar diagnoses (e.g., lumbosacral strain, degenerative arthritis, degenerative disc disease, IVDS, spinal stenosis, spondylolisthesis) plus “Other.” The examiner should include ICD codes and diagnosis dates when available, and explain in remarks if there is no diagnosis or if it differs from prior diagnoses.

If the Veteran reports flare-ups, the examiner should record the Veteran’s description (frequency, duration, triggers, relief, severity, and functional impact). The form also asks the examiner to estimate range of motion during flare-ups based on the Veteran’s statements, records, and medical judgment, even if the flare-up is not directly observed.

The DBQ requests thoracolumbar ROM values in degrees (flexion, extension, lateral flexion, and rotation) and asks about pain on active/passive motion and weight-bearing/nonweight-bearing. If any testing is not performed or is medically contraindicated, the examiner must explain why.

Observed repetitive-use testing is based on what happens after at least three repetitions during the exam. “Repeated use over time” asks the examiner to estimate additional functional loss/ROM limits that occur after ongoing use, using the Veteran’s statements, evidence, and medical expertise.

Sections VIII and related neuro sections document whether radiculopathy is present, the severity of pain/paresthesias/numbness, and which nerve roots are involved (femoral L2-L4 and/or sciatic L4-S3). The examiner should also explain the likely cause of abnormal neurologic findings.

Not necessarily. The form notes EMG studies are rarely required to diagnose radiculopathy in the appropriate clinical setting, and imaging is not required to diagnose IVDS; however, degenerative arthritis must be confirmed by imaging to be documented as arthritis.

For Section XI, an IVDS episode counts only if bed rest was prescribed by a physician and treatment by a physician occurred. The examiner must indicate the total duration in the past 12 months and identify documentation supporting it.

Section XII asks whether the Veteran uses assistive devices as a normal mode of locomotion and how often (occasional/regular/constant). If used, the examiner should specify which condition requires the device and, when relevant, the side affected.

Section XVI explains how the diagnosed back condition(s) affect the ability to perform occupational tasks such as standing, walking, lifting, or sitting. The examiner should provide specific examples and focus only on the impact of the diagnosed spine-related conditions (not age or unrelated conditions).

The form states VA reserves the right to confirm the authenticity of all completed questionnaires. That’s why the examiner’s certification, signature, credentials, license/NPI, and contact information are required and should be complete and legible.

Compliance VA DBQ Back (Thoracolumbar Spine)
Validation Checks by Instafill.ai

1
Patient/Veteran Identity Fields Present and Non-Empty
Validates that the Patient/Veteran name, Social Security Number, and Date of Examination fields are present and not blank. These are core identifiers required to associate the DBQ with the correct claimant and to establish the timing of the medical findings. If any are missing, the submission should be rejected or routed to manual review because the form cannot be reliably matched to a claim.
2
Social Security Number (SSN) Format and Plausibility
Checks that the SSN contains exactly 9 digits (allowing common formatting like XXX-XX-XXXX or spaced groups) and is not an obviously invalid value (e.g., all zeros, 000-00-0000). SSN format validation reduces misidentification and downstream matching errors with VA systems. If validation fails, the system should block submission and request correction, or require an alternate VA identifier if supported.
3
Date Fields Format and Chronological Consistency
Validates that all dates (e.g., Date of examination, Date signed, Date of diagnosis, imaging dates) follow an accepted format (MM/DD/YYYY or ISO) and represent real calendar dates. Also checks that the examiner signature date is on or after the examination date, and that diagnosis/imaging dates are not in the future relative to the exam date. If any date is invalid or inconsistent, the record should be flagged because it undermines medical timeline integrity and adjudication reliability.
4
Requestor Type Selection and Conditional Third-Party Details
Ensures exactly one requestor type is selected (Veteran/Claimant, Third party, or Other). If 'Third party' is selected, at least one organization/individual name must be provided; if 'Other' is selected, a description must be provided. If the selection is missing or conditional details are absent, the form should be returned for completion because provenance and authorization context are unclear.
5
In-Person Exam vs. Remote Exam Explanation Requirement
Validates that 'Was the Veteran examined in person?' is answered, and if 'No' is selected, the method of examination (telemedicine/video/records-only/other) is explicitly described. This is important because certain ROM and physical exam findings may not be valid without an in-person exam, and VA may weigh evidence differently. If 'No' is selected without an explanation, the submission should be flagged for medical adequacy review.
6
Evidence Review Selection and Date Range Completeness
Checks that the Evidence reviewed section is internally consistent: either 'No records were reviewed' is selected, or 'Records reviewed' is selected with evidence types and a date range populated. This supports traceability of medical opinions and ensures the examiner’s conclusions are grounded in documented sources when claimed. If records are marked as reviewed but no sources/date range are provided, the form should be considered incomplete and routed for correction.
7
Diagnosis Section Completeness: Claimed Conditions vs. Selected Diagnoses
Ensures that Section 1A (claimed conditions) is populated and that Section 1B is consistent: either at least one diagnosis is selected, or the 'no current diagnosis' option is selected with a required remarks explanation. This prevents contradictory submissions where conditions are claimed but no diagnostic conclusion is recorded. If inconsistency is detected, the system should require clarification before acceptance.
8
ICD Code and Diagnosis Date Requirements for Selected Diagnoses
For each checked diagnosis in Section 1B (including 'Other'), validates that an ICD code is present and matches a valid ICD-10 pattern (e.g., letter+2 digits with optional decimal), and that a diagnosis date is provided in valid date format (or explicitly marked approximate if the system supports it). This is important for standardized coding, analytics, and adjudication mapping. If missing/invalid, the system should flag the specific diagnosis line item and prevent finalization until corrected.
9
ROM Numeric Range and Unit Validation (Active/Passive/Repeated/Flare Estimates)
Validates that all ROM entries are numeric degrees and fall within plausible clinical bounds (e.g., flexion 0–90, extension 0–30, lateral flexion 0–30, rotation 0–30), and that left/right fields are not swapped or duplicated unintentionally. Also checks that if 'Same as active ROM' is selected for passive ROM, the passive numeric fields are not simultaneously populated with conflicting values. If values are out of range or contradictory, the system should block submission or require attestation/explanation because ROM drives rating criteria.
10
ROM Status Selection Requires Supporting Explanation When Not Testable
Ensures that if ROM is marked 'Unable to test' or 'Not indicated,' an explanation is provided, and that 'Can testing be performed?' is consistent with that status. This is required for medical adequacy because VA needs to know why objective measurements are missing (e.g., contraindication, severe pain, safety). If missing, the form should be returned for completion since the absence of ROM without rationale can invalidate the DBQ.
11
Pain Evidence and Functional Loss Narrative Consistency
Checks that if pain is indicated (weight-bearing/nonweight-bearing/active/passive/rest), the 'Causes functional loss' selection is consistent with the narrative comments and with earlier statements about functional loss. If 'Causes functional loss' is checked, a comment describing how pain limits function should be present; if 'Does not result in functional loss' is checked, the narrative should not claim pain-driven functional loss. Inconsistencies should trigger a validation error or manual review because they affect rating and credibility.
12
Repetitive Use Testing Logic and Required Follow-Up Fields
Validates that if the Veteran is able to perform repetitive use testing, the form includes whether there is additional loss after three repetitions; and if 'Yes,' the post-test ROM values and contributing factors are provided. If the Veteran is not able to perform repetitive testing, an explanation must be present. Missing follow-up data should fail validation because repetitive-use findings are required for functional loss assessment under VA criteria.
13
Repeated Use Over Time / Flare-Up Estimates Require Either ROM Estimates or Feasibility Explanation
Ensures that for Sections 3C and 3D, if procured evidence suggests significant limitation, the examiner provides estimated ROM values in degrees; if the examiner cannot estimate, a case-specific explanation is required. This is important because VA expects an estimate when possible even if not directly observed, and generic statements are insufficient. If neither estimates nor a specific rationale are provided, the submission should be flagged as medically inadequate.
14
Guarding/Muscle Spasm Selection Consistency with Gait/Contour Impact
Validates that selections for localized tenderness, muscle spasm, and guarding are internally consistent with whether they result in abnormal gait or abnormal spinal contour, and that any 'Provide description and/or etiology' fields are completed when a condition is present. This matters because gait/contour impact can change evaluation outcomes and supports clinical reasoning. If the form indicates abnormal gait without selecting the corresponding 'resulting in abnormal gait' option (or vice versa), it should be flagged for correction.
15
Muscle Strength/Atrophy Conditional Measurements
Checks that muscle strength grades are within the allowed 0–5 scale and are provided for required muscle groups, and that if muscle atrophy is marked 'Yes,' the location and circumference measurements (normal vs atrophied side) are completed in centimeters. This ensures objective documentation of neurologic/musculoskeletal impairment. If atrophy is indicated without measurements, the form should fail validation because the finding is not adequately supported.
16
Examiner Certification Block Completeness (Signature, Credentials, NPI, License, Contact)
Validates that the examiner signature, printed name/title, specialty, date signed, phone/fax, NPI, and medical license number/state and address are present and properly formatted (e.g., NPI is 10 digits; phone is 10 digits with optional separators; license includes state abbreviation). This is critical for authenticity verification and for VA’s ability to contact the provider. If any required credentialing fields are missing or malformed, the submission should be rejected or routed to credential verification review.

Common Mistakes in Completing VA DBQ Back (Thoracolumbar Spine)

Leaving patient identifiers incomplete or mismatched (Name/SSN/Exam date)

People often skip or partially fill the header fields (patient/veteran name, SSN, and date of examination) or enter values that don’t match the veteran’s claim file. This happens because the form starts with administrative items that feel “obvious” or are assumed to be on another page. Missing or inconsistent identifiers can delay processing or cause the DBQ to be rejected as not clearly attributable to the correct veteran. Always complete all header identifiers exactly as they appear in VA records and ensure the exam date reflects the actual evaluation date.

Not specifying who requested the DBQ (Veteran vs third party vs other)

A common error is checking a box without listing the required third-party organization/individual name(s), or selecting “Other” without a description. This occurs because the request source seems administrative, but VA uses it to understand context and potential conflicts. Incomplete requester information can trigger follow-up requests or questions about authenticity. If “Third party” is selected, list the full legal name(s); if “Other,” provide a clear explanation.

Contradictory exam modality answers (in-person vs not examined vs telehealth)

Examiners sometimes mark “Was the Veteran examined in person?” inconsistently with later remarks (e.g., stating face-to-face but earlier indicating “No,” or vice versa). This usually happens when copying prior templates or rushing through yes/no items. Contradictions can undermine credibility and lead VA to discount the DBQ or request a new exam. Ensure the modality answers are consistent across the checkbox section and the remarks (and describe the method if not in-person).

Evidence review section completed vaguely or without date ranges

Many submissions check “Records reviewed” but fail to identify which records were reviewed and the date range, or they list generic items without specifics. This happens because the prompt is easy to overlook and clinicians assume “STRs reviewed” is sufficient. VA may view the opinion as less probative if it’s unclear what evidence informed the findings. List the exact record types (STRs, VA treatment, private records) and include an approximate date range (e.g., 2012–2025).

Diagnosis section missing ICD codes and/or diagnosis dates

A frequent mistake is selecting diagnoses (e.g., lumbosacral strain, DDD, radiculopathy) but leaving ICD codes and diagnosis dates blank or mixing claimed conditions with confirmed diagnoses. This occurs because clinicians focus on narrative history and forget the structured fields. Missing codes/dates can create ambiguity about what is being diagnosed “today” versus historically, which can affect rating decisions. Provide ICD-10 codes when requested and use a clear diagnosis date (initial diagnosis date or the exam date if newly diagnosed).

Flare-up and functional loss questions answered “Yes” without required details

People often mark that flare-ups or functional loss exist but do not document frequency, duration, precipitating/alleviating factors, severity, and functional impact in the veteran’s own words. This happens because the narrative boxes are time-consuming and the form repeats similar concepts. Without these details, VA may be unable to evaluate severity accurately and may order another exam. Capture a structured description (how often, how long, what triggers, what helps, and what the veteran cannot do during flare-ups).

Range of motion (ROM) values entered in the wrong format or missing units/fields

Common data-entry errors include leaving ROM endpoints blank, entering text instead of degrees, swapping left/right values, or placing numbers in the wrong line (e.g., rotation values in flexion fields). This happens because the ROM table is dense and easy to misread, especially when transcribing from notes. Incorrect ROM entries can directly change the rating outcome or make the DBQ internally inconsistent. Enter numeric degree values for each movement, double-check left vs right, and confirm they align with the narrative and pain findings.

Pain testing not fully addressed (active vs passive; weight-bearing vs nonweight-bearing)

Examiners frequently document “pain present” but fail to specify whether pain occurs on active motion, passive motion, weight-bearing, and nonweight-bearing, or they don’t explain why testing wasn’t performed. This happens because these requirements are easy to miss and may not be part of routine clinical documentation. VA may consider the exam inadequate if these elements are omitted without explanation. Explicitly check all applicable pain contexts and, if any testing is not performed, provide a medically specific rationale.

Repetitive use/flare-up ROM estimates omitted or justified incorrectly

A very common issue is leaving the “repeated use over time” and “flare-ups” estimated ROM fields blank, or stating an estimate cannot be provided without giving a case-specific explanation. This happens because the veteran is rarely examined during a flare-up and clinicians hesitate to estimate. VA guidance expects an estimate based on procurable evidence (veteran statements, records, clinical judgment) unless truly not feasible, and inadequate explanations can lead to remand or re-exam. Provide estimated degrees when possible and cite the veteran’s description and clinical reasoning; if not feasible, explain specifically what information is missing and why it prevents estimation.

Muscle strength/reflex/sensory sections left incomplete or not aligned with radiculopathy conclusions

Submissions often state “bilateral radiculopathy” but leave strength grades, DTRs, sensory dermatomes, or straight leg raise results blank or inconsistent with the severity selected. This happens because the neuro exam spans multiple sections and it’s easy to overlook one table. Inconsistencies can cause VA to question the diagnosis or severity level and may reduce the weight of the DBQ. Complete all neuro objective fields and ensure the radiculopathy severity and nerve roots selected match the documented deficits.

IVDS and bed rest misunderstood (self-reported bed rest vs physician-prescribed)

Many people mark IVDS episodes requiring bed rest based on the veteran’s self-reported “staying in bed,” without confirming physician-prescribed bed rest and treatment. This happens because the term “bed rest” is interpreted casually, but VA’s criteria are specific. Incorrectly indicating prescribed bed rest can lead to credibility issues or an inaccurate rating basis. Only check bed-rest episodes if there is documentation of physician-prescribed bed rest and treatment, and list the supporting records, dates, and facility/provider.
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