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Hip and Thigh Conditions 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 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.
Fillable fields725
Pages13
Sections172
Tables and lists15
Questions that depend on earlier answers508
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 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.

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.

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.

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.

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.

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.

And 10 more checks
  • Diagnosis Selection vs 'No Current Diagnosis' Mutual Exclusivity
  • Diagnosis Entry Completeness (Side, ICD Code, Date of Diagnosis)
  • Other Diagnosis Free-Text Requires Supporting Fields
  • ROM Testing Status Requires Explanation When Not Performed
  • ROM Numeric Range and Unit Validation
  • Pain-on-ROM Selections Must Align With Pain Evidence and Comments
  • Repetitive-Use Testing Logic and Required Follow-Ups
  • Repeated Use Over Time / Flare-Up Estimates Require ROM or Feasibility Rationale
  • Muscle Atrophy Measurements and Causation Rationale
  • Surgery/Implant Entries Require Dates and Residual Severity When Applicable

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How to Fill Out VA DBQ (Hip and Thigh) Online for Free in 2026

What the AI walks you through.

  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.

Common Mistakes in Completing VA DBQ (Hip and Thigh)

The ones the AI is built to catch.

Missing patient identifiers and exam date at the top of the form
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).
Not specifying who requested the DBQ (Veteran vs third party) and leaving third-party details blank
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.
Inconsistent answers about in-person examination and how the exam was conducted
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).
Evidence review section completed incorrectly (checked boxes without listing records and date ranges)
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.
Diagnosis section errors: selecting “no current diagnosis” while also listing diagnoses, sides, or ICD codes
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.
Side affected confusion (Right/Left/Both) and mismatched Right:Left fields
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.
Missing or non-specific dates and codes (date of diagnosis, ICD code, surgery dates)
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).
Range of motion (ROM) entered without degrees, with wrong units, or copied as “normal” without measurements
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.
Not addressing required pain testing contexts (active vs passive; weight-bearing vs nonweight-bearing) or failing to explain why not
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).
Flare-up and repeated-use sections left blank or answered “unable to estimate” without case-specific rationale
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.
Assistive device section incomplete (frequency not selected, side/condition not linked in 9B)
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.
Examiner certification details missing (signature, credentials, NPI, license/state, contact info)
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.

Frequently Asked Questions About VA DBQ (Hip and Thigh)

 

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How does the AI fill out VA DBQ (Hip and Thigh)?
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 (Hip and Thigh), 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 (Hip and Thigh) to fill out?
VA DBQ (Hip and Thigh) has a Form Complexity Index of 100 out of 100, in the very complex tier: 725 fillable fields across 13 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 Hip and Thigh Conditions Disability Benefits Questionnaire (DBQ) used for?
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.
Who is supposed to complete and sign this DBQ?
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.
Will the VA pay my provider or reimburse costs for completing this form?
No. The form states VA will not pay or reimburse any expenses or costs incurred to complete and/or submit the DBQ.
Can this DBQ be completed without an in-person exam?
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.
What records should the examiner review in the Evidence Review section?
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.
What diagnoses can be listed, and do I need ICD codes and dates of diagnosis?
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).
What if the Veteran has symptoms but no current diagnosis?
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.
How should flare-ups be documented on this DBQ?
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.
What range of motion (ROM) measurements are required for the hip?
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.
What if ROM testing or contralateral joint testing cannot be performed?
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.
What is the difference between observed repetitive-use testing and repeated use over time?
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.
How are surgeries like total hip replacement documented on this form?
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.
Do scars from hip surgery need to be included?
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.
How should assistive devices (cane, walker, brace, wheelchair) be reported?
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.
What diagnostic testing is required for arthritis on this DBQ?
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.
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