Yes! You can use AI to fill out Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire
The Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire (DBQ) is an official VA medical evaluation form completed by a healthcare provider to support a Veteranâs claim for disability compensation involving the thoracolumbar spine. It captures key rating-related information such as diagnoses and ICD codes, flare-ups, active/passive range of motion measurements, repetitive-use limitations, radiculopathy/neurologic findings, IVDS episodes, assistive device use, diagnostic testing, and occupational functional impact. VA uses the completed DBQ as medical evidence when evaluating service connection and determining the appropriate disability rating. Today, this form can be filled out quickly and accurately using AI-powered services like Instafill.ai, which can also convert non-fillable PDF versions into interactive fillable forms.
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Form specifications
| Form name: | Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire |
| Number of pages: | 14 |
| Language: | English |
| Categories: | disability forms |
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How to Fill Out VA DBQ Back (Thoracolumbar Spine) Conditions Online for Free in 2026
Are you looking to fill out a VA DBQ BACK (THORACOLUMBAR SPINE) CONDITIONS form online quickly and accurately? Instafill.ai offers the #1 AI-powered PDF filling software of 2026, allowing you to complete your VA DBQ BACK (THORACOLUMBAR SPINE) CONDITIONS form in just 37 seconds or less.
Follow these steps to fill out your VA DBQ BACK (THORACOLUMBAR SPINE) CONDITIONS form online using Instafill.ai:
- 1 Go to Instafill.ai and upload the “Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire (DBQ)” PDF (or select it from the form library).
- 2 Enter or import the Veteran/patient identifiers and exam context (name, SSN, date of examination, requester, VA provider status, in-person vs. remote exam method).
- 3 Use Instafill.ai to extract and summarize evidence reviewed (service/VA/private records and date ranges) and populate the Evidence Review section.
- 4 Complete Section I–II by selecting the applicable thoracolumbar diagnoses, adding ICD codes and diagnosis dates, and documenting medical history, flare-ups, and reported functional loss.
- 5 Fill the ROM and functional limitation sections (active/passive ROM, pain indicators, repetitive-use testing, repeated use over time estimates, flare-up estimates, guarding/spasm, and other contributing factors).
- 6 Complete neurologic and related sections (strength, atrophy, reflexes, sensory, straight leg raise, radiculopathy details, ankylosis, other neurologic abnormalities, IVDS/bed rest, assistive devices, and remaining effective function).
- 7 Review the diagnostic testing, functional impact, and remarks; then finalize examiner certification fields (signature, credentials, specialty, NPI, license/state, contact info, address, and date signed) and export/share the completed form for submission.
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Frequently Asked Questions About Form VA DBQ Back (Thoracolumbar Spine) Conditions
This DBQ documents a Veteranâs thoracolumbar spine diagnosis, symptoms, exam findings, and functional impact for a VA disability claim. VA uses it as medical evidence when evaluating the claim.
It is intended to be completed by the Veteranâs healthcare provider (examiner), who must certify and sign it. The Veteran can provide history and symptom descriptions, but the medical sections and certification should be completed by a licensed clinician.
No. The form states that VA will not pay or reimburse any expenses or costs incurred to complete and/or submit the DBQ.
Youâll need the Patient/Veteranâs full name, Social Security Number, and the date of examination. These identifiers help VA match the DBQ to the correct claim.
The examiner must indicate whether records were reviewed and, if so, list what was reviewed (e.g., service treatment records, VA records, private records) and the date range. Records review is not always required, but the form asks the examiner to clearly document what was or wasnât reviewed.
Check all diagnoses that apply (e.g., degenerative arthritis, IVDS, lumbosacral strain) and provide ICD codes and diagnosis dates for each. If there are additional diagnoses not listed, use the âOtherâ fields and the âadditional diagnosesâ line.
The examiner can check the box stating there is no current diagnosis, but must explain the findings and reasons in the Remarks section. This explanation is important because VA may rely on it when deciding the claim.
If flare-ups are reported, the form asks for frequency, duration, characteristics, triggers, relief factors, severity, and functional impact. Functional loss should be documented in the Veteranâs own words, including limitations after repeated use over time.
The examiner records thoracolumbar ROM in degrees for active motion (flexion, extension, lateral flexion, and rotation) and, when performed, passive ROM as well. The form also asks which movements are painful and whether ROM loss contributes to functional loss.
The examiner should select the appropriate âunable/contraindicated/not necessaryâ option and provide a clear explanation. VA expects a reason when testing is not performed, especially if it could worsen pain or risk injury.
The form asks the examiner to estimate additional functional loss (including ROM in degrees) after repeated use over time and during flare-ups based on the Veteranâs statements, available records, and medical expertise. If an estimate truly isnât feasible, the examiner must explain why, using case-specific reasoning.
Radiculopathy sections document radiating pain, numbness/tingling, severity, and nerve roots involved (e.g., femoral or sciatic). IVDS documents whether disc syndrome is present and whether there were physician-prescribed bed-rest episodes in the last 12 months; the straight leg raise test is one exam tool that can support radiculopathy findings.
The DBQ specifically asks about bed rest prescribed by a physician and treatment by a physician. If the âyesâ answer is based only on the Veteranâs report without documentation, the examiner must indicate that and provide supporting details as requested.
The examiner indicates whether the Veteran uses devices like a cane, brace, walker, crutches, or wheelchair and how often (occasional/regular/constant), plus which condition requires them. The functional impact section describes how the diagnosed back condition affects work-like activities (standing, walking, lifting, sitting), with examples.
YesâAI tools can help organize information and auto-fill form fields; services like Instafill.ai use AI to accurately populate fields and save time. If your PDF is flat/non-fillable, Instafill.ai can convert it into an interactive fillable form and then guide you to upload the DBQ, map fields, and export a completed version for your provider to review, sign, and date.
Compliance VA DBQ Back (Thoracolumbar Spine) Conditions
Validation Checks by Instafill.ai
1
Patient/Veteran Name is present and appears to be a full legal name
Validate that the Patient/Veteran Name field is not blank and contains at least two alphabetic name components (e.g., first and last name), not just initials or placeholders like "N/A". This is important for identity matching and to prevent misfiling in the Veteranâs claim record. If validation fails, block submission and prompt for the Veteranâs full name as it appears in official records.
2
Patient/Veteran Social Security Number (SSN) format and plausibility
Ensure the SSN is exactly 9 digits (allowing optional hyphens in the pattern ###-##-####) and is not an obvious invalid value (e.g., all zeros, 123456789). Correct SSN formatting is critical for VA identity resolution and record linkage. If validation fails, reject the SSN entry and require correction before submission.
3
Date of Examination is a valid date and not in the future
Check that Date of Examination is a valid calendar date (MM/DD/YYYY or ISO format per system standard) and is not later than the submission date. This prevents impossible timelines and supports auditability of the clinical encounter. If validation fails, require a corrected date and prevent finalization until resolved.
4
Requester type selection is mutually exclusive and complete
Validate that exactly one requester option is selected among Veteran/Claimant, Third party, or Other (no multiple selections and not left blank). This is important because downstream routing and attestation requirements can differ based on who requested the DBQ. If validation fails, prompt the user to select one requester type and clear conflicting selections.
5
Third-party requester names required when 'Third party' is selected
If the Third party checkbox is selected, require Requester Third Party Names to be populated with at least one organization/individual name and disallow generic entries like "unknown". This ensures transparency and supports authenticity checks referenced in the form instructions. If validation fails, block submission and request the missing third-party name(s).
6
‘Other requester’ description required when 'Other' is selected
If the Other requester option is selected, require Requester Other Description to be non-empty and sufficiently descriptive (e.g., minimum character count) rather than a single word. This prevents ambiguous provenance of the questionnaire request. If validation fails, require a clearer description before allowing submission.
7
In-person examination logic: method required when not examined in person
If 'Was the Veteran examined in person?' is marked No, require Non-In-Person Examination Method to be completed (e.g., telehealth, records review only) and not left blank. This is necessary to interpret the reliability of physical findings and ROM measurements. If validation fails, prompt for the examination method and prevent completion until provided.
8
Evidence review consistency: details required when records were reviewed
If 'Records reviewed' is selected, require Evidence Reviewed Details to include at least one record type and a date range (or explicit dates) in a recognizable format. This supports the formâs requirement to identify evidence and enables audit trails. If validation fails, require the evidence description/date range or switch the selection to 'No records were reviewed' if appropriate.
9
Diagnosis selection consistency: at least one diagnosis or explicit 'no current diagnosis' with remarks
Validate that either (a) at least one diagnosis checkbox is selected, or (b) 'The Veteran does not have a current diagnosis...' is selected, but not both. If 'no current diagnosis' is selected, require an explanatory entry in Remarks (or a designated findings explanation field) to document rationale. If validation fails, prevent submission and require correction to avoid contradictory clinical conclusions.
10
ICD code required and formatted for each selected diagnosis
For every checked diagnosis (including Other diagnoses), require the corresponding ICD Code field to be populated and match an ICD-10-CM-like pattern (e.g., letter + 2 digits + optional decimal and additional characters). This is important for standardized coding, analytics, and claim processing. If validation fails, flag the specific diagnosis row and require a valid ICD code.
11
Date of diagnosis required and logically consistent for each selected diagnosis
For each selected diagnosis, require a Date of diagnosis and validate it is a real date not in the future and not after the Date of Examination (unless the system allows same-day initial diagnosis). This ensures temporal consistency and reduces downstream adjudication questions. If validation fails, require correction of the date(s) or an explanatory remark if policy allows exceptions.
12
ROM measurement completeness when testing is performed
If 'Can testing be performed?' is Yes and initial ROM is not marked 'Unable to test' or 'Not indicated', require all six active ROM degree fields (flexion, extension, left/right lateral flexion, left/right rotation) to be present. Complete ROM data is essential for VA rating criteria and functional assessment. If validation fails, highlight missing ROM fields and prevent finalization.
13
ROM degree values are numeric and within medically plausible bounds
Validate that ROM entries are numeric (no text) and fall within plausible ranges (e.g., 0â120 for flexion, 0â60 for extension/lateral flexion/rotation, with system-configurable thresholds). This prevents data entry errors such as swapped units or typos (e.g., 900 degrees). If validation fails, require correction and optionally warn when values are extreme but still possible.
14
Passive ROM logic: explanation required when not performed; values required when performed
If passive ROM testing is marked No, require one reason selection (medically contraindicated/testing not necessary/other) and a non-empty explanation. If passive ROM testing is marked Yes, require passive ROM endpoints or allow 'Same as active ROM' selections, but not both blank. If validation fails, prompt for the missing reason/explanation or missing passive ROM values.
15
Conditional narrative requirements for key Yes/No items (flare-ups, functional loss, pain, tenderness)
When the Veteran reports flare-ups (2B Yes), require the flare-up description; when functional loss is reported (2C Yes), require the functional loss description; when pain evidence is Yes and 'Pain causes functional loss' is checked, require Pain Comments; when localized tenderness is Yes, require Tenderness or Pain Description. These narratives are necessary to interpret checkbox selections and support adjudication. If validation fails, block submission and direct the user to the specific missing narrative field.
16
Examiner certification block completeness and identifier format checks (signature, dates, NPI, phone, license)
Require Examinerâs signature, printed name/title, specialty, date signed, and address to be present; validate Date Signed is a valid date and not before the Date of Examination. Validate NPI is exactly 10 digits (numeric) and phone/fax numbers follow an accepted format; require medical license number and state to be present and state to be a valid US/territory abbreviation. If validation fails, prevent submission because the DBQ cannot be authenticated without a complete certification section.
Common Mistakes in Completing VA DBQ Back (Thoracolumbar Spine) Conditions
People often leave the Patient/Veteran name, Social Security Number, or date of examination blank, or enter a nickname, transposed SSN digits, or an exam date that doesnât match the actual encounter. This can cause the DBQ to be rejected, misfiled, or delayed because VA cannot reliably associate it with the correct claim. Always use the Veteranâs legal name as it appears in VA records, verify the SSN digit-by-digit, and use the actual exam date (not the date you completed paperwork). AI-powered tools like Instafill.ai can help by validating required identifiers and formatting dates consistently.
A common error is checking âThird partyâ or âOtherâ but not listing the organization/individual names or providing the required description, or checking multiple requester boxes inconsistently. This creates ambiguity about who requested the DBQ and can trigger follow-up requests or authenticity checks. Choose exactly one requester category and complete the associated detail fields when required (third-party names or âotherâ description). Instafill.ai can prompt for the dependent fields when a related checkbox is selected so the section is complete.
Examiners frequently check âRecords reviewedâ but fail to identify which records and the date range, or they check âNo records were reviewedâ while later citing imaging/notes. VA relies on this section to understand the basis of medical opinions and estimates, and inconsistencies can reduce credibility or require clarification. If records were reviewed, list the specific sources (e.g., STRs, VA treatment records, private records) and the date range; if none were reviewed, avoid referencing them later unless you correct the selection. Instafill.ai can help standardize evidence lists and ensure the date range is captured.
A frequent mistake is selecting âThe Veteran does not have a current diagnosisâŠâ and also checking one or more diagnoses (or listing âOther diagnosisâ entries). This contradiction can lead to VA returning the DBQ for correction or discounting the diagnosis section. Only select âno current diagnosisâ if truly no diagnosis applies, and then explain in Remarks; otherwise, select the applicable diagnoses and leave the âno diagnosisâ box unchecked. Using Instafill.ai can reduce contradictory selections by flagging mutually exclusive options.
Clinicians often check a diagnosis (e.g., degenerative arthritis, IVDS, lumbosacral strain) but leave the ICD code and date of diagnosis blank or enter non-standard codes. This can weaken the medical documentation and may prompt VA to request additional clarification or an exam. For each checked diagnosis, provide the ICD code (as used in your system) and an accurate or approximate diagnosis date (including âapprox.â when appropriate). Instafill.ai can auto-format ICD entries and remind you to complete required companion fields.
In Sections 2B and 2C, many submissions use vague statements like âhas flare-upsâ or âpain with activityâ without frequency, duration, triggers, alleviating factors, severity, and functional impact in the Veteranâs own words. VA uses these details to evaluate functional impairment, and missing specifics can lead to an underrating or a request for a new exam. Document the Veteranâs description with concrete details (e.g., how often, how long, what activities worsen it, what helps, and what they cannot do during flare-ups). Instafill.ai can guide structured entry so all required flare-up elements are captured.
A common data-entry issue is recording ROM in percentages, using âWNLâ instead of degrees, swapping endpoints between movements, or entering values that exceed the formâs reference endpoints (e.g., flexion > 90°) without explanation. Incorrect ROM data can directly affect the rating outcome and may cause VA to question the examâs validity. Always record numeric degrees for each movement, double-check left vs right fields, and explain any unusual values or testing limitations. Instafill.ai can validate numeric ranges and enforce degree-only formatting.
The DBQ specifically asks for pain on active vs passive motion and weight-bearing vs nonweight-bearing, but many forms only note âpain presentâ without selecting the applicable checkboxes or providing comments on functional loss. This can make the exam noncompliant with VA expectations and lead to addendum requests. If pain is present, indicate where it occurs (active/passive, weight-bearing/nonweight-bearing, rest) and whether it causes functional loss, then describe that loss in the comments. Instafill.ai can help ensure all required pain modalities are addressed before submission.
Sections 3C and 3D often get left blank when the Veteran is not examined after repeated use or during a flare-up, or the examiner states they cannot estimate ROM without providing a specific, case-based explanation. VA guidance expects an estimate based on procurable information (Veteran statements, records, clinical judgment), and inadequate rationale can result in a returned exam or reduced probative value. Provide estimated ROM in degrees when possible and cite the evidence used; if not feasible, explain why in a case-specific way (not a general statement). Instafill.ai can prompt for the required evidence discussion when âNoâ is selected for being examined during flare-ups/repeated use.
Many people mark âYesâ for IVDS episodes requiring bed rest based on the Veteran resting at home, but the form requires bed rest prescribed by a physician and treatment by a physician in the past 12 months. Overstating this can create credibility issues, while understating it can reduce the rating if true prescribed bed rest exists. Only select âYesâ if there is documentation of physician-prescribed bed rest and provide the supporting record dates, facility/provider, and treatment details. Instafill.ai can help by prompting for the required documentation fields when IVDS bed-rest is marked âYes.â
Itâs common to check a cane/brace/walker/wheelchair but forget to mark frequency (occasional/regular/constant) or to complete the follow-up describing the condition, side, and device used. VA uses this to understand functional limitations, and missing details can lead to follow-up development or a less accurate assessment. For each device, select the frequency and specify which condition necessitates it and which side is affected (when applicable). Instafill.ai can enforce completion of frequency and the narrative mapping of device-to-condition.
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