Yes! You can use AI to fill out Hip and Thigh Conditions Disability Benefits Questionnaire
The Hip and Thigh Conditions Disability Benefits Questionnaire (DBQ) is a standardized medical form used by the U.S. Department of Veterans Affairs to evaluate hip and thigh conditions for disability benefits. It captures key clinical details such as diagnoses, medical history, range-of-motion measurements (including pain and repetitive use effects), surgical history, imaging results, and functional impact on work and daily activities. VA uses the completed DBQ as medical evidence to help determine service connection and assign a disability rating. It is typically completed and certified by a qualified healthcare provider, and VA may verify the authenticity of the submission.
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Form specifications
| Form name: | Hip and Thigh Conditions Disability Benefits Questionnaire |
| Number of pages: | 13 |
| Language: | English |
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How to Fill Out VA DBQ (Hip and Thigh) Online for Free in 2026
Are you looking to fill out a VA DBQ (HIP AND THIGH) form online quickly and accurately? Instafill.ai offers the #1 AI-powered PDF filling software of 2026, allowing you to complete your VA DBQ (HIP AND THIGH) form in just 37 seconds or less.
Follow these steps to fill out your VA DBQ (HIP AND THIGH) form online using Instafill.ai:
- 1 Enter Veteran/patient identifying information (name, Social Security number, and date of examination) and indicate who requested the DBQ (Veteran/claimant, third party, or other).
- 2 Complete examiner and exam context details: VA provider status, whether the Veteran is a regular patient, whether the exam was in person (and if not, how it was conducted), and list evidence/records reviewed with date ranges.
- 3 Document Section I (Diagnosis): list claimed conditions, select all applicable hip/thigh diagnoses, specify side affected (right/left/both), and provide ICD codes and diagnosis dates; add any “other” diagnoses as needed.
- 4 Fill Section II (Medical History): summarize onset/course, record flare-ups (frequency, duration, triggers, severity), and describe functional loss after repeated use over time in the Veteran’s own words.
- 5 Complete Section III (ROM and Functional Limitation): record active and passive ROM for each hip, note pain on weight-bearing/nonweight-bearing and active/passive motion, perform repetitive-use testing, and estimate ROM during repeated use over time and flare-ups with supporting rationale when required.
- 6 Finish remaining clinical sections: muscle atrophy measurements, ankylosis, femur/flail hip impairment and leg length discrepancy, surgical procedures and residuals, scars/other findings, assistive devices, remaining effective function, and diagnostic testing/imaging results.
- 7 Provide Section XII functional impact on occupational tasks, add any remarks, then complete examiner certification with signature, credentials, specialty, contact information, NPI, license details, and address before generating the final submission copy.
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Frequently Asked Questions About Form VA DBQ (Hip and Thigh)
This DBQ documents a Veteran’s hip and/or thigh medical conditions and functional limitations for the VA to consider when evaluating a disability benefits claim. The information may be used along with other records and exams to decide service connection and rating.
It is intended to be completed by the Veteran’s healthcare provider (VA or non-VA). The examiner must certify the information and provide signature, credentials, and licensing details in the certification section.
No. The form states VA will not pay or reimburse any expenses or costs incurred to complete and/or submit the DBQ.
Yes, but the provider must indicate whether the Veteran was examined in person and, if not, explain how the examination was conducted. The provider should still base findings on available evidence and clinical judgment.
The examiner should indicate whether records were reviewed and list what was reviewed (e.g., service treatment records, VA treatment records, private treatment records) and the date range. If no records were reviewed, that should be clearly selected.
The form includes common hip/thigh diagnoses (e.g., osteoarthritis, trochanteric pain syndrome, femoroacetabular impingement, avascular necrosis, hip replacement) and allows “Other” diagnoses. For each diagnosis, the examiner should identify the side affected, provide an ICD code if available, and include the date of diagnosis (exact or approximate).
The examiner can select that the Veteran does not have a current diagnosis associated with the claimed conditions and must explain the findings and reasoning in the Remarks section. The VA may seek additional information or an exam if needed.
If flare-ups are reported, 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 loss during flare-ups based on the Veteran’s statements, records, and medical expertise, or explain why an estimate is not feasible.
The DBQ requests active and passive ROM values for flexion, extension, abduction, adduction, external rotation, and internal rotation for each hip. It also asks whether pain is present on active/passive motion and on weight-bearing/nonweight-bearing, and whether adduction limitation prevents crossing the legs.
If testing is “Unable to test” or cannot be performed (including passive/active or weight-bearing/nonweight-bearing), the examiner must provide a medical explanation (e.g., severe pain or risk of injury). If the opposite (unclaimed) joint is undamaged, ROM testing is generally expected unless contraindicated.
Observed repetitive-use testing records objective changes after at least three repetitions during the exam. “Repeated use over time” asks the examiner to estimate additional functional loss that would occur after prolonged use based on the Veteran’s statements, evidence, and medical probability, even if not directly observed.
The Surgical Procedures section asks the examiner to check the type of surgery (e.g., resurfacing, total hip replacement, arthroscopic repair), provide the date, and describe residuals. For total hip replacement, the examiner must select the level of residual weakness/pain/limitation of motion, including whether crutches are required.
Yes. If the Veteran has scars or skin disfigurement related to the condition or its treatment, the examiner should mark “Yes” and complete the appropriate dermatological questionnaire as instructed.
The examiner should indicate whether assistive devices are used as a normal mode of locomotion, identify which devices are used, and note frequency (occasional/regular/constant). The form also asks the examiner to link each device to the condition and side involved.
Degenerative or post-traumatic arthritis must be confirmed by imaging studies at least once. If arthritis has already been documented by imaging in the past, the form notes that additional imaging is not required by VA even if the condition has worsened, but the examiner should summarize any imaging reviewed.
Compliance VA DBQ (Hip and Thigh)
Validation Checks by Instafill.ai
1
Patient/Veteran Identifiers Present and Non-Placeholder
Validates that the Patient/Veteran name and Social Security Number fields are not blank and do not contain placeholder text (e.g., 'N/A', 'unknown', or repeated characters). These identifiers are required to correctly associate the DBQ with the correct claimant and prevent misfiling into the wrong record. If validation fails, the submission should be rejected or routed to a correction workflow before acceptance.
2
Social Security Number (SSN) Format and Disallowed Values
Checks that the SSN is exactly 9 digits (optionally allowing hyphens in the ###-##-#### pattern) and is not an invalid/disallowed value (e.g., all zeros, 123456789, 999999999). Correct SSN formatting is critical for downstream VA matching and reduces manual reconciliation. If invalid, the system should block submission and prompt for correction.
3
Date Fields Validity and Chronological Consistency
Ensures all dates (Date of examination, Date of diagnosis, surgery dates, diagnostic test dates, Date Signed) are valid calendar dates and follow a consistent format (e.g., YYYY-MM-DD). Also checks logical ordering, such as Date Signed not preceding Date of examination, and surgery dates not occurring after the examination date unless explicitly allowed by business rules. If inconsistencies are found, the form should be flagged for review or returned for correction to avoid inaccurate medical timelines.
4
Requestor Type Selection and Conditional Third-Party Details
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. This is important for provenance and auditability of who initiated the DBQ. If missing, the submission should be considered incomplete and not accepted.
5
Examination Modality Completeness (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 provided. This information affects interpretation of objective findings and compliance with exam requirements. If the modality explanation is missing, the system should require completion before submission.
6
Evidence Review Selection and Evidence Details When Applicable
Validates that the Evidence reviewed section is completed by selecting either 'No records were reviewed' or 'Records reviewed' (not both). If 'Records reviewed' is selected, the evidence types and date range must be provided to support medical opinions and ROM estimates. If evidence details are missing, the form should be flagged because it weakens the basis for conclusions and may be non-compliant.
7
Diagnosis Selection vs 'No Current Diagnosis' Mutual Exclusivity
Ensures that if 'The Veteran does not have a current diagnosis...' is checked, no other diagnoses are selected in Section I. Conversely, if any diagnosis is selected, the 'no current diagnosis' option must be unchecked. This prevents contradictory clinical assertions that can invalidate rating decisions. If violated, the system should block submission and require reconciliation.
8
Diagnosis Entry Completeness (Side, ICD Code, Date of Diagnosis)
For each selected diagnosis, validates that the side affected is specified (Right/Left/Both) and that ICD code and date of diagnosis are provided when the form expects them. If 'Both' is selected, the system should ensure it is not simultaneously recorded as separate conflicting right/left entries unless explicitly supported by the data model. If incomplete, the submission should be returned because missing coding/side/date reduces clinical clarity and impacts adjudication.
9
Other Diagnosis Free-Text Requires Supporting Fields
When 'Other specified forms of arthropathy', 'Inflammatory other types', or 'Other (specify)' is used, validates that the specification text is present and meaningful (not blank or 'see above'). Also requires side affected, ICD code (if required by workflow), and date of diagnosis for each 'Other diagnosis #1-#3' entry. If missing, the system should prompt for completion to avoid ambiguous diagnoses.
10
ROM Testing Status Requires Explanation When Not Performed
Validates that for each hip, the initial ROM status is selected (All normal/Abnormal/Unable to test/Not indicated). If 'Unable to test' or 'Not indicated' is selected, an explanation must be provided, and if the contralateral (unclaimed) joint is marked 'Undamaged', ROM testing must be present unless medically contraindicated with an explanation. If these conditions are not met, the form should be flagged as non-compliant with ROM documentation requirements.
11
ROM Numeric Range and Unit Validation
Checks that all ROM endpoints are numeric values in degrees (no text) and fall within plausible physiological bounds (e.g., not negative, not excessively above normal such as >180 for hip flexion). Also validates that 'Same as active ROM' is not selected while a conflicting numeric value is entered for passive ROM. If out-of-range or conflicting, the system should require correction to prevent erroneous functional limitation calculations.
12
Pain-on-ROM Selections Must Align With Pain Evidence and Comments
If 'Is there evidence of pain?' is marked 'Yes', at least one applicable context (weight-bearing, nonweight-bearing, active, passive, rest) should be selected, and if 'causes functional loss' is checked, a comment describing how it causes functional loss must be provided. If pain is marked 'No', pain-specific ROM checkboxes should not be selected. Failures should trigger validation errors because pain documentation directly affects functional loss assessment.
13
Repetitive-Use Testing Logic and Required Follow-Ups
Validates that if the Veteran is able to perform repetitive-use testing, the 'additional loss after three repetitions' question is answered, and if 'Yes', post-test ROM values are provided. If the Veteran is not able to perform repetitive-use testing, an explanation is required and post-test ROM fields should be empty. If inconsistent, the system should block submission to avoid incomplete or contradictory repetitive-use findings.
14
Repeated Use Over Time / Flare-Up Estimates Require ROM or Feasibility Rationale
If procured evidence suggests significant limitation with repeated use over time or flare-ups, the form should include estimated ROM values in degrees for the affected joint(s). If the examiner indicates it is not feasible to provide an estimate, a case-specific explanation and cited evidence discussion must be present (not generic statements). If missing, the submission should be flagged because VA guidance expects either estimates or a substantiated rationale.
15
Muscle Atrophy Measurements and Causation Rationale
When muscle atrophy is marked 'Yes', validates that the location of measurement and both circumferences (normal side and atrophied side) are provided in centimeters and are logically consistent (atrophied side should generally be smaller than the normal side). If atrophy is marked not due to the claimed condition, a rationale must be provided. If these requirements are not met, the form should be returned because atrophy impacts severity and etiology determinations.
16
Surgery/Implant Entries Require Dates and Residual Severity When Applicable
If any surgical procedure is selected (resurfacing, total hip replacement, arthroscopic repair, other), a surgery date must be provided, and for total hip replacement, a residual severity selection must be made (or 'None'). If 'Other surgery not described' is selected, the type of surgery must be specified. If missing, the submission should be rejected as incomplete because surgical history and residuals are key rating elements.
Common Mistakes in Completing VA DBQ (Hip and Thigh)
People often skip the header fields (Patient/Veteran name, Social Security Number, and Date of examination) because they assume VA already has the information or it will be added later. Missing identifiers can cause the DBQ to be rejected, misfiled, or delayed because it cannot be reliably matched to the correct claim. Always complete every header field exactly as it appears in VA records and ensure the exam date reflects when the evaluation occurred (not when the form is submitted).
A common error is checking “Third party” but not listing the organization/individual, or selecting “Other” without a description. This creates ambiguity about the purpose and provenance of the report and can trigger follow-up requests to confirm authenticity. To avoid delays, select one request source and, if “Third party” or “Other” is chosen, clearly list names and a brief explanation.
Clinicians sometimes mark “Was the Veteran examined in person? No” but forget to explain the alternative method (telehealth, records review, etc.), or they provide a vague explanation. VA may question the adequacy of findings (especially ROM and pain testing) if the exam method is unclear. If the exam was not in person, explicitly document the modality, what was assessed, and any limitations (e.g., ROM not measurable remotely).
Many submissions check “Records reviewed” but fail to identify which records were reviewed and the date range, or they check “No records were reviewed” even though they reference imaging or prior notes later. This inconsistency undermines credibility and can lead VA to discount opinions or request clarification. Always list the specific sources (STRs, VA treatment records, private ortho notes, imaging reports) and the exact date range reviewed.
A frequent mistake is checking “The Veteran does not have a current diagnosis…” and then also selecting conditions like osteoarthritis or bursitis, or leaving the contradiction unresolved. Conflicting diagnosis information can invalidate the DBQ or force VA to order another exam. Only select “no current diagnosis” if truly applicable, and if the diagnosis differs from prior records, explain the discrepancy in Remarks with clinical reasoning.
People often mark “Both” but then leave the Right:Left subfields blank, or they select Right/Left inconsistently across sections (e.g., right hip OA but left hip replacement). This can lead to incorrect ratings or the wrong extremity being evaluated. For every diagnosis and functional finding, confirm laterality and keep it consistent throughout the form, using the Right:Left fields when prompted.
It’s common to leave “Date of diagnosis,” ICD codes, or surgery dates blank, or to enter vague entries like “years ago.” VA uses dates to establish chronicity, progression, and post-surgical rating periods, so missing dates can reduce probative value or delay adjudication. Provide the best available approximate date (month/year) when exact dates are unknown, and document the source (records review vs patient report).
A major error is failing to enter numeric degree endpoints for flexion/extension/abduction/adduction/rotation, entering percentages, or writing narrative text where degrees are required. VA ratings for hip/thigh conditions heavily depend on degree measurements, so incomplete ROM data often results in an inadequate exam. Use a goniometer when possible, enter degrees for each movement, and ensure values are plausible relative to the listed normal endpoints on the form.
Examiners frequently document pain generally but do not specify whether pain was present on active motion, passive motion, weight-bearing, and nonweight-bearing, or they skip contralateral testing without justification. VA requires these elements unless medically contraindicated; missing them can trigger a remand or a new exam. Complete each pain context checkbox and, if any testing cannot be performed, provide a clear medical rationale (risk of injury, severe pain, post-op restrictions).
Many DBQs fail to estimate additional functional loss during flare-ups or after repeated use over time, especially when not directly observed, or they provide a generic statement like “cannot determine.” VA expects an estimate based on procurable evidence (Veteran statements, records, clinical judgment), and unsupported non-estimates can make the DBQ inadequate. Ask the Veteran for frequency/duration/severity and functional limits, then provide estimated ROM in degrees or a detailed, case-specific explanation of why an estimate is not feasible.
People often check that a cane/walker is used but forget to mark frequency (occasional/regular/constant) or they leave 9B blank, which should tie the device to a specific condition and side. This can lead to underestimation of functional impact or follow-up development. Always select frequency for each device and explicitly state which hip/thigh diagnosis necessitates it and whether it is for the right, left, or both sides.
A common administrative failure is submitting the DBQ without a signature, printed name/title, specialty, NPI, license number/state, or date signed. VA may reject the form or question authenticity, causing significant delays. Before submission, verify all certification fields are complete, legible, and consistent with the examiner’s professional records, and include a reachable phone/fax for verification.
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