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Foot Conditions, Including Flatfoot (Pes Planus) Disability Benefits Questionnaire, page 1
Very Complex · 100/100Form Complexity Index

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What this form asks for

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The Foot Conditions, Including Flatfoot (Pes Planus) Disability Benefits Questionnaire (DBQ) is a standardized medical form intended to be completed by a healthcare provider for the U.S. Department of Veterans Affairs. It captures the Veteran’s foot-related diagnoses, history, exam findings, treatments, imaging results, and functional impact in a format VA uses to evaluate service-connected disability claims and assign ratings. Accurate completion is important because VA relies on these structured responses to determine severity, side affected, and occupational/functional limitations. The form also includes examiner certification to support the credibility and authenticity of the medical evidence submitted.
Fillable fields790
Pages16
Sections173
Tables and lists3
Questions that depend on earlier answers730
Form Complexity IndexVery Complex, 100/100

The AI checks your answers before you download

16 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

Patient/Veteran Identifiers Present and Properly Formatted

Validates that the Patient/Veteran name and Social Security Number (SSN) fields are not blank and that the SSN matches an accepted format (e.g., 9 digits with optional dashes). This is critical to correctly associate the DBQ with the right claimant and prevent misfiling into another Veteran’s record. If validation fails, the submission should be rejected or routed to manual review with a clear error indicating which identifier is missing/invalid.

Examination Date and Signature Date Are Valid Dates and Chronologically Consistent

Checks that 'Date of examination' and 'Date Signed' are present and parseable as valid calendar dates (MM/DD/YYYY or system-approved format). Also verifies that the signature date is on or after the examination date and not in the future beyond an allowed tolerance. If the dates are invalid or inconsistent, the form should be flagged because it undermines the legal/clinical validity of the attestation and exam timing.

Requester Type Selection Completeness (Veteran/Third Party/Other)

Ensures exactly one requester type is selected (Veteran/Claimant, Third party, or Other) and that required follow-up text is provided when applicable. If 'Third party' is selected, at least one organization/individual name must be entered; if 'Other' is selected, a description must be provided. If validation fails, the submission should be blocked because the request context affects authorization, provenance, and downstream processing.

In-Person Exam Logic and Remote Exam Method Requirement

Validates that 'Was the Veteran examined in person?' is answered, and if 'No' is selected, the 'how was the examination conducted?' field is completed with a meaningful method (e.g., telehealth, records review only). This is important because certain findings may require physical examination and VA may weigh evidence differently based on exam modality. If missing, the form should be returned for completion or flagged for adjudicator review.

Evidence Review Consistency and Date Range Requirement

Checks that the evidence review section is internally consistent: either 'No records were reviewed' is selected or 'Records reviewed' is selected, but not both. If 'Records reviewed' is selected, the evidence types and a date range must be provided (start and end dates, or a clearly stated single date). If validation fails, the submission should be flagged because the basis for medical opinions and diagnosis dating becomes unclear.

Section I Claimed Conditions Required and Aligned With Diagnoses

Ensures 1A (claimed conditions) is not blank and that the claimed conditions reasonably map to at least one diagnosis selection in 1B or an explicit statement that no current diagnosis exists. This prevents submissions where the DBQ is completed without specifying what is being evaluated. If the claimed conditions are missing or do not align with the diagnosis section, the form should be rejected or routed to manual review.

And 10 more checks
  • Diagnosis Selection Mutual Exclusivity (No Diagnosis vs. Any Diagnosis)
  • Diagnosis Detail Completeness: Side Affected, ICD Code, and Date of Diagnosis
  • Conditional Narrative Requirements for Yes/No Questions (Pain, Flare-ups, Functional Loss)
  • Side-Affected Required When a Symptom/Sign Is Marked Present
  • Orthopedic Shoes/Appliances Improvement Fields Must Match Trigger Conditions
  • Plantar Fasciitis Treatment Pathway Consistency (Non-surgical vs Surgical vs Recommended)
  • Hallux Valgus Surgery Details Required When Surgery Is Yes
  • Foot Surgery Section XII Completeness and Residuals Dependency
  • Pain on Physical Exam vs. Reported Pain Rationale Requirement
  • Examiner Credentialing and Contact Information Format Validation (NPI, License, Phone/Fax)

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How to Fill Out VA DBQ (Foot Conditions/Flatfoot) Online for Free in 2026

What the AI walks you through.

  1. Enter Veteran/patient identifiers and exam details (name, SSN, date of examination) and indicate who requested the DBQ and whether the exam was in person.
  2. Complete the Evidence Review section by listing which records were reviewed (service, VA, private) and the applicable date ranges.
  3. Fill out Section I (Diagnosis) by selecting all applicable foot diagnoses, specifying side affected, ICD codes (if available), and dates of diagnosis; add any additional diagnoses as needed.
  4. Complete the Medical History section by summarizing onset/course, documenting pain, flare-ups, and any reported functional loss in the Veteran’s own words.
  5. Work through the condition-specific sections (e.g., Flatfoot, Plantar Fasciitis, Morton’s Neuroma/Metatarsalgia, Hammer Toes, Hallux Valgus/Rigidus, Pes Cavus, Malunion/Nonunion, Other Foot Injuries) and answer all symptom/severity and side-affected questions that apply.
  6. Document pain findings, functional loss factors, assistive devices, remaining effective function, diagnostic testing/imaging results, and occupational functional impact, adding comments/remarks where clarification is needed.
  7. Complete the examiner certification and signature block (printed name/title, specialty, date signed, contact info, NPI, license details, and address) and generate a final review copy for submission to VA.

Common Mistakes in Completing VA DBQ (Foot Conditions/Flatfoot)

The ones the AI is built to catch.

Missing patient identifiers and exam date
People often leave the top identifiers blank (Patient/Veteran name, SSN, and Date of examination) because they assume the VA already has them or they’re on another page. Missing identifiers can cause the DBQ to be rejected, misfiled, or delayed because it cannot be reliably matched to the correct claim. Always complete all header fields exactly as they appear in the Veteran’s records and use a clear exam date (MM/DD/YYYY).
Not indicating who requested the DBQ (Veteran vs third party vs other)
The requestor question is frequently skipped or answered ambiguously, especially when a clinic staff member is helping complete paperwork. This can raise authenticity questions or trigger follow-up requests because VA may need to understand the context of the exam and who initiated it. Check exactly one option and, if “Third party” or “Other,” list the organization/person and provide a brief description.
Inconsistent answers about in-person examination and evidence review
A common error is checking “Was the Veteran examined in person? No” but not explaining how the exam was conducted, or stating “Records reviewed” without listing what records and date ranges. These inconsistencies reduce the credibility and usefulness of the DBQ and can lead VA to order a new C&P exam. If the exam was not in person, clearly document the method (telehealth, records-only, etc.) and, for evidence review, list record types and date ranges.
Selecting a diagnosis without completing the corresponding sections
Clinicians sometimes check a diagnosis in Section I (e.g., pes planus, plantar fasciitis, hallux valgus) but leave the related detailed sections (Sections III–XI) blank. VA rating criteria rely on those symptom/severity checkboxes, so missing sections can result in an underrating or a request for clarification. After checking any diagnosis, complete Section 1, Section 2, and every condition-specific section tied to the diagnosis.
Side mismatch (Right/Left/Both) across the form
It’s very common to mark “Both” in the diagnosis table but then mark only “Right” (or leave blank) in symptom questions, treatment history, or functional loss sections. Side inconsistencies create doubt about accuracy and can lead to incorrect ratings for one foot or delays for reconciliation. Use the same side designation consistently and double-check that each “If yes, indicate side affected” line is completed whenever “Yes” is selected.
Leaving ICD codes and diagnosis dates blank or using non-specific dates
In Section 1B, ICD codes and dates of diagnosis are often omitted, or the date is entered as a vague timeframe (e.g., “years ago”) without an approximate date. Missing or unclear diagnosis details can weaken the medical evidence and prompt VA to seek additional documentation. Provide the ICD-10 code when known and use a specific date or a clearly stated approximate date (e.g., “~2018” based on records/history).
Contradictory pain reporting between history and physical exam
A frequent issue is documenting pain in Section II (history) but marking “No pain on physical exam” in Section XIII without providing the required rationale. VA expects reconciliation when subjective reports and objective findings differ; without it, the DBQ may be considered incomplete. If pain is reported but not observed on exam, explain why (e.g., intermittent symptoms, pain only after prolonged standing, good day at exam, analgesics taken).
Incomplete flare-up and repeated-use functional loss details
When “Yes” is checked for flare-ups or functional loss (Sections 2C, 2D, 14B, 14C), people often provide minimal text like “has flare-ups” without frequency, duration, triggers, alleviating factors, and functional impact. This happens because the prompts are long and easy to under-document, but VA ratings depend heavily on functional limitations during flare-ups and after repeated use. Capture the Veteran’s own words and include concrete details (how often, how long, what activities become limited, and specific examples).
Misunderstanding arch supports/orthotics questions (relief vs tried)
In Section 3E and related “improved by orthopedic shoes or appliances” items, respondents often check both “complete relief” and “tried but remains symptomatic,” or they fail to specify which side is relieved/not relieved. These questions map to severity criteria for pes planus and can materially affect the rating. Choose the single best description for each device and clearly indicate the side(s) for relief versus non-relief.
Not documenting treatment history details for plantar fasciitis and surgeries
Sections IV and XII are often answered with a simple “Yes” to treatment or surgery but without dates, side, type of procedure, or whether symptoms were relieved. Missing treatment specifics can lead VA to discount the evidence or request operative notes and follow-up records. Always include side, approximate dates, what was tried (PT, injections, night splints, orthotics), and whether each intervention relieved symptoms.
Failing to confirm arthritis with imaging or not listing imaging results
The form explicitly states that degenerative or post-traumatic arthritis must be confirmed by imaging, yet people frequently check an arthritis diagnosis without documenting imaging studies or results in Section XVIII. This can cause VA to disregard the arthritis diagnosis for rating purposes or order additional testing. If arthritis is claimed/diagnosed, document the imaging type (X-ray/MRI), date, and a brief result summary, even if the imaging was done previously.
Missing examiner certification details (signature, credentials, NPI, license, address)
DBQs are commonly delayed because the examiner’s signature block is incomplete—missing printed name/title, specialty, date signed, NPI, license number/state, or contact information. VA may question authenticity or be unable to verify the provider, which can trigger rejection or follow-up. Complete every field in Section XXI legibly and ensure the credentials match the provider who performed/reviewed the exam.

Frequently Asked Questions About VA DBQ (Foot Conditions/Flatfoot)

 

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How does the AI fill out VA DBQ (Foot Conditions/Flatfoot)?
You answer a few questions in plain words, or upload a document you already have. The AI reads what you give it and puts each answer into the right field of VA DBQ (Foot Conditions/Flatfoot), on every page, in seconds. It checks the answers against the form's own rules, and you review and change anything before you download, print or sign.
What happens to my information?
It is encrypted in transit and at rest, and it is never used to train AI.
How complex is VA DBQ (Foot Conditions/Flatfoot) to fill out?
VA DBQ (Foot Conditions/Flatfoot) has a Form Complexity Index of 100 out of 100, in the very complex tier: 790 fillable fields across 16 pages. Instafill.ai's AI fills it in under a minute, with every field there for you to review before you download.
What is the Foot Conditions (Including Flatfoot/Pes Planus) Disability Benefits Questionnaire (DBQ) used for?
This DBQ is a medical form used to document a Veteran’s foot diagnoses, symptoms, functional limitations, and test results for a VA disability claim. VA uses the information as evidence when evaluating the claim.
Who is supposed to complete this DBQ—the Veteran or a medical provider?
It is intended to be completed by the Veteran’s healthcare provider (examiner). The Veteran can provide symptom history and descriptions, but the clinician must document exam findings and certify/sign the form.
Will VA pay my doctor or reimburse costs for completing this form?
No. The form states VA will not pay or reimburse any expenses or costs incurred to complete or submit the DBQ.
Does the exam have to be done in person?
The form asks whether the Veteran was examined in person, and if not, it requires the examiner to explain how the examination was conducted. If an in-person exam is not done, the provider should clearly document the method and supporting evidence used.
What records should the examiner review and list in the Evidence Review section?
The examiner should indicate whether records were reviewed and identify what was reviewed (e.g., service treatment records, VA records, private records) and the date range. Listing relevant records helps VA understand what evidence supported the medical findings.
What diagnoses can be documented on this DBQ?
The DBQ covers many foot conditions such as pes planus, plantar fasciitis, Morton's neuroma, metatarsalgia, hammer toes, hallux valgus/rigidus, pes cavus, malunion/nonunion, foot injuries, arthritis types, gout, bursitis, and tendinopathy. The examiner can also add “Other” diagnoses and specify the side affected.
How do we indicate whether the condition affects the right foot, left foot, or both?
Most diagnosis and symptom questions include checkboxes for Right, Left, or Both. The examiner should be consistent across sections so the side affected matches the diagnosis and the described findings.
What should be included in the Medical History section about pain, flare-ups, and functional loss?
The Veteran’s descriptions should be recorded in their own words, including pain details, flare-up frequency/duration/triggers, and how symptoms limit function (especially after repeated use). This section is important because VA considers both clinical findings and reported functional impact.
In the Flatfoot (Pes Planus) section, what does “pain accentuated on use/manipulation” mean?
It means the examiner finds that pain increases with activity (use) or when the foot is physically manipulated during the exam. The form requires the examiner to indicate whether pain is present and whether it is accentuated, and to specify the side affected.
How should arch supports or built-up shoes be documented for flatfoot?
The examiner should indicate whether arch supports or built-up shoes provide complete relief or whether the Veteran tried them but remains symptomatic. The form also asks which side is relieved or not relieved.
What information is needed for plantar fasciitis treatment history?
The DBQ asks whether the Veteran had non-surgical treatment and/or surgery, whether each relieved symptoms, and which side was treated. If surgery was recommended but the Veteran was not a surgical candidate, that should also be documented with the affected side.
Do X-rays or imaging studies have to be done for this DBQ?
Not always. The form notes that plain or weight-bearing X-rays are not required to diagnose flatfoot, but degenerative or post-traumatic arthritis must be confirmed by imaging; once arthritis is documented, VA does not require repeat imaging even if it worsens.
How is “functional loss” evaluated on this DBQ?
The examiner checks contributing factors (e.g., pain, weakness, swelling, disturbance of locomotion, interference with standing) and addresses limitations during flare-ups or repeated use over time. The form also asks about pain on active/passive motion and weight-bearing/nonweight-bearing when feasible.
What if the Veteran reports pain but the examiner does not find pain on physical exam?
The Pain section asks the examiner to provide a rationale if there is no pain on exam but pain is reported in the history. This explanation helps VA reconcile subjective reports with objective findings.
What does the question about “amputation with prosthesis would equally serve the Veteran” mean?
It is not a recommendation for amputation; it is a way to document whether the foot condition causes such severe functional impairment that balance/propulsion would be no better than with an amputation and prosthesis. If “Yes,” the examiner must specify which extremity and provide examples of the loss of effective function.
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