Yes! You can use AI to fill out Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire
This form is a Department of Veterans Affairs (VA) Disability Benefits Questionnaire (DBQ) focused on thoracolumbar spine (low/mid-back) conditions. It captures standardized medical evidence—such as diagnoses, flare-ups, range-of-motion testing (active/passive, weight-bearing/nonweight-bearing), neurologic findings (radiculopathy), IVDS episodes, imaging, and occupational functional impact. VA uses the completed DBQ as medical evidence to help determine service connection and assign a disability rating. It is intended to be completed by the Veteran’s healthcare provider, and VA may verify authenticity and request additional exams or records.
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Form specifications
| Form name: | Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire |
| Number of pages: | 14 |
| 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 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 and performed an in-person exam.
- 2 Complete the Evidence Review section by listing which records were reviewed (service, VA, private) and the applicable date ranges.
- 3 Document Section I–II: list claimed conditions, select/enter diagnoses with ICD codes and diagnosis dates, and summarize medical history, onset/course, flare-ups, and functional loss statements.
- 4 Record Section III range-of-motion findings: active and passive ROM values, pain on motion (active/passive; weight-bearing/nonweight-bearing), repetitive-use results, and estimated ROM during repeated use over time and flare-ups with supporting rationale.
- 5 Complete physical and neurologic findings (Sections IV–X): muscle strength/atrophy, reflexes, sensory testing, straight leg raise, radiculopathy details (symptoms, nerve roots, severity), ankylosis, and any other neurologic abnormalities.
- 6 Finish remaining clinical sections (XI–XVI): IVDS and physician-prescribed bed rest history, assistive devices, remaining effective function of extremities, scars/other findings, diagnostic testing/imaging results, and functional impact on work activities.
- 7 Add any clarifying remarks, then complete the examiner certification with signature, credentials, specialty, contact information, NPI, license details, address, and date signed before generating the final submission-ready copy.
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Frequently Asked Questions About Form VA DBQ - Back (Thoracolumbar Spine)
This DBQ documents a Veteran’s thoracolumbar (mid-to-low back) spine condition so VA can evaluate a disability claim. VA uses the medical findings in this form as evidence when deciding service connection and/or a disability rating.
It is intended to be completed by a licensed healthcare provider (examiner), not the Veteran. The examiner must certify the information and provide signature, credentials, and license/NPI details in Section XVIII.
No. The form states VA will not pay or reimburse any expenses or costs incurred to complete or submit the DBQ.
The form asks whether the Veteran was examined in person, and if not, how the examination was conducted. If it was not in person, the examiner should clearly document the method used and any limitations.
The examiner should indicate whether records were reviewed and list what was reviewed (e.g., service treatment records, VA treatment records, private records) and the date range. If no records were reviewed, that must be selected and documented.
Section I includes common thoracolumbar diagnoses (e.g., degenerative arthritis, degenerative disc disease, lumbosacral strain, IVDS, spinal stenosis) plus “Other” options. The examiner should include ICD codes and diagnosis dates when available, and explain in remarks if there is no diagnosis or it differs from prior history.
If the Veteran reports flare-ups, the examiner should record the Veteran’s description, including frequency, duration, triggers, relief measures, severity, and functional impact (Section II). The form also asks the examiner to estimate range-of-motion loss during flare-ups in degrees when possible (Section III-D).
VA requests detailed ROM testing to understand functional loss and pain under different conditions. If any testing cannot be performed or is medically contraindicated, the examiner must explain why in the ROM section.
Observed repetitive use testing measures whether ROM or function worsens after at least three repetitions (Section III-B). If the Veteran cannot perform it, the examiner must explain the reason and still address functional loss based on available evidence when possible.
Yes, the form requests estimated ROM during flare-ups and after repeated use over time based on all procurable information, including the Veteran’s statements and medical evidence (Sections III-C and III-D). If an estimate is not feasible, the examiner must provide a case-specific explanation.
The form uses symptoms (pain, numbness, paresthesias), objective findings (strength, reflexes, sensation), straight leg raise results, and identification of nerve roots (femoral and/or sciatic) to document radiculopathy (Sections VII and VIII). EMG is noted as rarely required in the appropriate clinical setting.
For VA purposes on this form, IVDS episodes must require bed rest prescribed by a physician and treatment by a physician in the past 12 months (Section XI). The examiner should indicate whether this is supported only by Veteran history or by documented records and list the relevant treatment dates/facility.
Not always. The form notes imaging is required to confirm degenerative or post-traumatic arthritis, but imaging is not required to diagnose IVDS, and EMG is rarely required for radiculopathy (Section XV).
If the Veteran uses assistive devices as a normal mode of locomotion, the examiner should check the device type and frequency (occasional/regular/constant) and specify which condition and side the device is used for (Section XII).
The examiner should describe how the diagnosed thoracolumbar condition(s) affect occupational tasks such as standing, walking, lifting, or sitting, with examples. The form instructs the examiner to address only the impact of the diagnosed condition(s), not age or unrelated medical issues (Section XVI).
Compliance VA DBQ - Back (Thoracolumbar Spine)
Validation Checks by Instafill.ai
1
Patient/Veteran Identity Fields Present (Name, SSN, Exam Date)
Validates that the Patient/Veteran name, Social Security Number, and Date of examination are all provided and not left blank. These fields are essential to correctly associate the DBQ with the right claimant and to establish the timing of clinical findings. If any are missing, the submission should be rejected or routed to an exception workflow for completion before acceptance.
2
Social Security Number Format and Plausibility
Checks that the SSN is exactly 9 digits (optionally formatted as XXX-XX-XXXX) and contains only valid characters. Also flags clearly invalid values (e.g., all zeros, repeated digits, or known invalid prefixes if your system enforces them). If validation fails, the form should not be accepted because it risks misidentification and downstream claim matching errors.
3
All Dates Use Valid Format and Logical Timeline
Ensures all date fields (Date of examination, Date of diagnosis for each diagnosis, diagnostic test dates, Date Signed) are valid calendar dates in an accepted format (e.g., YYYY-MM-DD). Also checks logical consistency: diagnosis dates and imaging dates should not be after the Date Signed, and the Date Signed should not precede the Date of examination. Failures should trigger an error requiring correction because date logic affects eligibility, rating periods, and auditability.
4
Requestor Type Selection and Third-Party Details Completeness
Validates that 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 is required. If missing or multiple selections occur, the submission should be flagged because provenance of the DBQ is a key authenticity and compliance element.
5
Examination Modality Consistency (In-Person vs Not In-Person)
Checks that 'Was the Veteran examined in person?' is answered, and if 'No' is selected, the method of examination (e.g., telehealth, records review) is explicitly described. This is important because certain measurements (e.g., ROM testing) may be limited or not feasible without an in-person exam. If the method is missing, the form should be returned for clarification to prevent unsupported clinical findings.
6
Evidence Review Section Completeness and Date Range When Records Reviewed
Validates that the evidence reviewed choice is consistent: either 'No records were reviewed' or 'Records reviewed' (not both). If 'Records reviewed' is selected, the evidence types and a date range must be provided. If this fails, the submission should be flagged because the basis for medical opinions and estimates (e.g., repeated use/flare-up ROM estimates) must be traceable.
7
Diagnosis Selection vs 'No Current Diagnosis' Mutual Exclusivity
Ensures that if 'The Veteran does not have a current diagnosis...' is checked, no specific diagnoses are also checked in Section I. Conversely, if any diagnosis is checked, the 'no diagnosis' option must be unchecked. If violated, the form should be rejected for correction because it creates a direct contradiction that undermines rating and medical interpretation.
8
Diagnosis Detail Requirements (ICD Code and Date of Diagnosis)
For each selected diagnosis (including 'Other diagnosis #1-#3'), validates that an ICD code is present (in an expected ICD-10 format if enforced) and a date of diagnosis is provided or explicitly marked as approximate per policy. This is important for standardization, analytics, and adjudication support. If missing, the system should require completion or a remarks-based justification before allowing submission.
9
Flare-Ups and Functional Loss Narrative Required When Answered 'Yes'
Checks that if the Veteran reports flare-ups (2B = Yes), the flare-up description fields include frequency and functional impact details (not just a single word). Similarly, if functional loss/impairment is reported (2C = Yes), the Veteran’s description must be populated. If narratives are missing, the form should be returned because these statements drive ROM estimates and functional impact determinations.
10
ROM Testing Feasibility and Explanation When Not Performed
Validates that 'Can testing be performed?' is answered, and if 'No' is selected, an explanation is provided. Also checks that if Initial ROM is marked 'Unable to test' or 'Not indicated,' the required explanation fields are completed. If absent, the submission should be flagged because VA requirements expect a medical rationale when ROM data are not obtained.
11
ROM Numeric Range and Units Validation (Degrees)
Ensures all ROM endpoints entered are numeric values in degrees and fall within plausible bounds (e.g., not negative, not excessively above normal reference values such as flexion far beyond 90 without explanation). Also validates that left/right lateral flexion and rotation values are provided when testing is performed. If values are non-numeric or out-of-range, the system should block submission to prevent unusable or clinically implausible data.
12
Passive ROM Section Consistency (Performed vs Same-as-Active vs Explanation)
Checks that if passive ROM testing is marked 'Yes,' passive ROM values are provided or 'Same as active ROM' is consistently selected per movement. If passive ROM testing is 'No,' one reason (medically contraindicated / not necessary / other) must be selected and an explanation provided. Failures should be flagged because passive ROM is a required reporting element unless properly justified.
13
Repetitive Use Testing Logic and Required Follow-Up Values
Validates that if the Veteran can perform repetitive use testing (3B = Yes) and additional loss after three repetitions is marked 'Yes,' then post-test ROM values for all movements are completed and at least one causal factor is selected. If the Veteran cannot perform repetitive testing (3B = No), an explanation is required. If inconsistent, the form should be returned because the repetitive-use findings are central to functional loss evaluation.
14
Repeated Use Over Time / Flare-Up ROM Estimates or Required 'Not Feasible' Rationale
If procured evidence suggests significant limitation with repeated use over time or flare-ups (3C/3D = Yes), validates that estimated ROM values are provided for all movements. If the examiner indicates it is not feasible to estimate, the 'why' explanation and case-specific evidence citation fields must be completed (not generic statements). If missing, the submission should be blocked because VA guidance requires an estimate or a medically supported explanation.
15
IVDS Bed Rest Episodes Documentation Completeness
Ensures that if IVDS is present (11A = Yes) and physician-prescribed bed rest episodes are reported (11B = Yes), a total duration category is selected and supporting documentation details are provided (record dates and facility/provider, or an explicit selection that it is based on documented file vs history only). This is important because IVDS incapacitating episodes affect rating criteria and require substantiation. If documentation fields are empty, the form should be flagged for insufficient support.
16
Examiner Certification Block Completeness and Identifier Formats (NPI, License, Phone/Fax)
Validates that the examiner signature, printed name/title, specialty, date signed, address, and at least one contact number are present. Also checks that NPI is a 10-digit numeric identifier and that medical license number includes a state/jurisdiction. If any are missing or malformed, the submission should be rejected or routed for correction because examiner identity and credentials are required for authenticity verification and audit trails.
Common Mistakes in Completing VA DBQ - Back (Thoracolumbar Spine)
People often leave the header fields blank or enter identifiers that don’t match the Veteran’s claim file (e.g., nickname vs. legal name, transposed SSN digits, missing exam date). This can cause the DBQ to be rejected, misfiled, or delayed because VA cannot reliably associate it with the correct claimant and encounter. Always copy identifiers directly from official records, double-check SSN digit order, and use the actual date the exam was performed (not the date the form was printed or signed).
A common error is checking multiple requestor options or selecting “Third party” without listing the organization/individual. This creates ambiguity about the purpose and provenance of the report and can trigger follow-up requests to verify authenticity. Select exactly one requestor category and, if “Third party” or “Other,” provide the full name and a brief description of the request context.
Examiners sometimes mark “Was the Veteran examined in person? No” but fail to describe how the exam was conducted, or they mark “Yes” while later indicating testing could not be performed without rationale. VA relies on this to judge adequacy of objective findings, especially ROM and neurologic testing. If not in-person, specify telehealth type (video/phone), what objective data sources were used, and what could not be assessed; if in-person but limited, document the medical reason for limitations.
Many submissions check “Records reviewed” but do not identify which records (STRs, VA, private) or the date range, or they check “No records were reviewed” despite referencing imaging later. This undermines credibility and can lead VA to discount opinions that should be grounded in the file. List each evidence type reviewed and include an approximate date range (e.g., “VA treatment records 2018–2025; private MRI report 03/2024”).
A frequent mistake is checking “The Veteran does not have a current diagnosis” while also selecting specific diagnoses, or selecting diagnoses but leaving ICD codes and diagnosis dates blank. This creates internal inconsistency and can prevent VA from assigning the correct service-connected condition and evaluation. Only select diagnoses that are supported by the exam and/or records, and complete ICD code and an approximate diagnosis date (or explain in remarks if unknown).
People often write a brief narrative like “chronic back pain” and skip the required flare-up elements (frequency, duration, precipitating/alleviating factors, severity, functional impact). VA rating criteria heavily depend on functional loss during flare-ups and repeated use, so missing detail can reduce the probative value of the DBQ. Capture the Veteran’s description verbatim where possible and include concrete examples (e.g., “flare-ups 2–3x/week lasting 4–6 hours; triggered by bending; relieved by rest/heat; cannot sit >15 minutes”).
A common data-entry issue is recording ROM in percentages, inches, or narrative terms instead of degrees, or entering values that exceed the form’s reference endpoints (e.g., flexion >90°) without explanation. Implausible or non-standard entries can cause VA to question accuracy and request a new exam. Always record numeric degrees, ensure left/right fields are not swapped, and if a value is atypical, explain why (e.g., hypermobility) in the provided comment areas.
Examiners frequently document active ROM but omit passive ROM, or they fail to indicate whether pain is present on weight-bearing vs. nonweight-bearing and whether pain causes functional loss. The DBQ explicitly requires these elements or a medical reason why they cannot be performed, and missing them can render the exam inadequate. Either complete each required pain/ROM subsection or clearly state why testing was not performed (e.g., medically contraindicated due to severe pain/risk of injury).
A very common mistake is writing “cannot determine without resorting to speculation” without citing case-specific evidence or explaining why an estimate is not feasible. VA expects an estimate based on procurable information (Veteran statements, records, clinical judgment) even if the flare-up is not observed. Provide estimated degrees for each plane when possible and cite the Veteran’s reported limitations and supporting records; if truly not feasible, give a specific, case-based explanation (not a generic statement).
Many people mark IVDS episodes requiring bed rest based on the Veteran saying they stayed in bed, but the form requires bed rest prescribed by a physician and treatment by a physician. Overstating this can lead to credibility issues and incorrect rating pathways, while understating it can miss a higher evaluation if documentation exists. Only check “Yes” if there is documentation of prescribed bed rest and list the dates, facility/provider, and treatment record references.
It’s common to mark radicular pain as present but leave nerve roots/side blank, or to record abnormal strength/reflex/sensation yet not explain the likely cause in Section 8D. VA uses these details to determine separate neurologic ratings and laterality, so omissions can reduce or delay benefits. Ensure symptoms, severity, laterality, nerve roots involved, and the likely etiology are consistent with Sections 4–7 findings and are explicitly tied together in 8D.
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