Yes! You can use AI to fill out Neck (Cervical Spine) Conditions Disability Benefits Questionnaire
The Neck (Cervical Spine) Conditions DBQ is a U.S. Department of Veterans Affairs medical questionnaire completed by a qualified healthcare provider to support a Veteran’s VA disability compensation claim. It captures standardized clinical findings such as cervical spine diagnoses, range-of-motion measurements (including pain and repetitive-use effects), radiculopathy/neurologic abnormalities, IVDS episodes, imaging results, and occupational functional impact. VA uses this information to help determine service connection and assign an appropriate disability rating under VA rating criteria. Accurate, complete entries and provider certification are important because VA may verify authenticity and rely on the DBQ as medical evidence in adjudication.
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Form specifications
| Form name: | Neck (Cervical Spine) Conditions Disability Benefits Questionnaire |
| Number of pages: | 14 |
| Language: | English |
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How to Fill Out VA DBQ - Neck (Cervical Spine) Conditions Online for Free in 2026
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Follow these steps to fill out your VA DBQ - NECK (CERVICAL SPINE) CONDITIONS form online using Instafill.ai:
- 1 Enter Veteran/patient identifiers and exam details (name, SSN, date of exam), then indicate who requested the DBQ and whether the examiner is a VA provider and performed an in-person exam.
- 2 Complete Evidence Review and Dominant Hand sections by listing records reviewed (type and date range) and selecting the Veteran’s dominant hand.
- 3 Document Section I (Diagnosis) by listing claimed cervical spine conditions, selecting all applicable diagnoses, and providing ICD codes and diagnosis dates; add any additional diagnoses as needed.
- 4 Fill Section II (Medical History) by summarizing onset/course, noting flare-ups (frequency, duration, triggers, severity), and describing functional loss after repeated use over time in the Veteran’s own words.
- 5 Record Section III (ROM and Functional Limitations) by entering active and passive ROM values, identifying where pain occurs, documenting repetitive-use testing results, and estimating ROM during repeated use over time and flare-ups with supporting rationale when required.
- 6 Complete clinical findings sections (IV–XIV) including muscle strength/atrophy measurements, reflexes, sensory testing, radiculopathy details (symptoms and nerve roots), ankylosis, other neurologic abnormalities, IVDS/bed-rest history, assistive devices, remaining effective function, scars/other findings, and diagnostic imaging/test results.
- 7 Finish Section XV–XVII by describing occupational functional impact, adding any remarks, and completing examiner certification with signature, credentials, specialty, contact information, NPI, license details, and address before generating the final submission-ready form.
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Frequently Asked Questions About Form VA DBQ - Neck (Cervical Spine) Conditions
This DBQ documents a Veteran’s neck/cervical spine diagnoses, symptoms, exam findings, and functional impact for the VA to consider when evaluating a disability claim. It is medical evidence that supports the VA’s rating decision.
It is intended to be completed by the Veteran’s healthcare provider (examiner). The Veteran can provide history and symptom descriptions, but the clinician must perform/record the medical findings and sign the certification.
No. The form states VA will not pay or reimburse any expenses or costs incurred to complete and/or submit the DBQ.
No. The form asks whether the examiner is a VA provider, but non-VA clinicians can complete it; the VA may still review authenticity and may request additional information or an exam if needed.
Not always, but the form asks whether the Veteran was examined in person and, if not, how the exam was conducted. If key testing (like range of motion) cannot be performed, the examiner must explain why.
The examiner should indicate whether records were reviewed and list what was reviewed (e.g., service treatment records, VA records, private records) along with the date range. If no records were reviewed, that must be selected.
Section I includes common cervical spine diagnoses (e.g., cervical strain, degenerative arthritis, degenerative disc disease, IVDS, stenosis, spondylolisthesis, fracture, fusion) and “Other.” If there is no current diagnosis, the examiner must select that option and explain the findings in Remarks.
Arthritis (degenerative or post-traumatic) must be confirmed by imaging to be documented as arthritis. Imaging is not required to diagnose IVDS, and EMG is rarely required for radiculopathy in the appropriate clinical setting.
If the Veteran reports flare-ups, the examiner should record frequency, duration, characteristics, triggers, relieving factors, severity, and functional impairment during flare-ups. The form also asks the examiner to estimate range-of-motion limits during flare-ups when supported by the available evidence.
Initial ROM is measured at the exam; observed repetitive-use ROM is measured after at least three repetitions. “Repeated use over time” and “flare-ups” may require the examiner to estimate additional limitation based on the Veteran’s statements, records, and medical judgment even if not directly observed.
The examiner must indicate whether testing can be performed and, if not, provide a specific explanation (e.g., medically contraindicated due to severe pain or risk of injury). The form requires documentation of why any testing was not done.
Radiculopathy can be identified by characteristic radiating pain/sensory changes plus objective findings (reflex, strength, or sensation changes). EMG studies are noted as rarely required when the clinical picture supports the diagnosis.
The DBQ only counts episodes that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The examiner must document supporting records or explain the basis for the response.
If the Veteran uses an assistive device as a normal mode of locomotion, the examiner should check the device type and frequency (occasional/regular/constant). The form also asks the examiner to link each device to the condition and side involved.
It describes how the diagnosed cervical spine condition(s) affect the ability to perform occupational tasks (e.g., lifting, sitting, standing, turning the head, driving). The examiner should provide examples and focus only on the impact of the diagnosed neck condition(s), not age or unrelated conditions.
Compliance VA DBQ - Neck (Cervical Spine) Conditions
Validation Checks by Instafill.ai
1
Patient/Veteran Identifiers Present and Properly Formatted
Validates that the Patient/Veteran name is provided and that the Social Security Number is present and formatted as 9 digits (optionally with dashes as XXX-XX-XXXX). This is critical to correctly associate the DBQ with the right claimant and prevent misfiled medical evidence. If missing or malformed, the submission should be rejected or routed to manual review with a request for corrected identifiers.
2
Examination Date and Signature Date Are Valid and Chronologically Consistent
Checks that the Date of examination and Date Signed are valid dates and not in the future, and that Date Signed is on or after the Date of examination. This ensures the report reflects a real clinical encounter and that certification occurred after the exam content was generated. If the dates are invalid or inconsistent, the form should fail validation and require correction before acceptance.
3
Requester Type Selection Completeness (Veteran/Third Party/Other)
Ensures exactly one requester 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 must be provided. If these dependencies are not met, the form should be flagged as incomplete because the request context is required for auditability and authenticity checks.
4
In-Person Exam vs. Remote Exam Explanation Requirement
Validates that 'Was the Veteran examined in person?' is answered, and if 'No' is selected, the method of examination (e.g., telehealth, records review) is documented in the follow-up field. This is important because ROM and neurologic findings may be limited or interpreted differently without an in-person exam. If 'No' is selected without an explanation, the submission should be rejected or returned for completion.
5
Evidence Review Selection and Date Range/Source Completeness
Checks that the Evidence reviewed section is completed (No records were reviewed vs Records reviewed). If 'Records reviewed' is selected, the evidence types and a date range must be provided. If missing, the form should fail validation because VA adjudication relies on knowing what records informed the clinician’s conclusions.
6
Dominant Hand Selection Must Be Exactly One
Ensures the Dominant hand field has exactly one selection among Right, Left, or Ambidextrous. Dominance affects interpretation of strength, functional impact, and extremity impairment. If multiple or none are selected, the form should be flagged for correction to avoid ambiguous clinical interpretation.
7
Diagnosis Section Consistency: 'No Current Diagnosis' vs. Selected Diagnoses
Validates that if 'The Veteran does not have a current diagnosis...' is checked, no specific diagnoses (e.g., cervical strain, IVDS) are also checked, and a rationale is provided in Remarks. Conversely, if any diagnosis is selected, the 'no diagnosis' option must not be selected. If inconsistent, the submission should be rejected because it creates a direct contradiction in the medical opinion basis.
8
ICD Code and Date of Diagnosis Format for Each Selected Diagnosis
For each checked diagnosis (including 'Other diagnosis #1-#3'), verifies an ICD code is present and matches an expected ICD-10 pattern (e.g., letter+2 digits with optional decimal), and that Date of diagnosis is a valid date (or explicitly allowed approximate date format if supported by the system). This supports standardized coding and downstream analytics/claims processing. If missing or malformed, the form should be returned for correction or routed to manual coding review.
9
Flare-Ups and Functional Loss Narrative Required When Answered 'Yes'
Checks that if the Veteran reports flare-ups (Section 2B = Yes), the flare-up description includes at least a minimal narrative (frequency/duration/severity or functional impact). Similarly, if functional loss/impairment is Yes (Section 2C), the Veteran’s description must be provided. If narratives are missing, the form should be flagged as incomplete because VA rating criteria often depend on these functional descriptions.
10
ROM Testing Feasibility and Explanation When Not Performed
Validates that the ROM testing feasibility question ('Can testing be performed?') is answered, and if 'No' is selected, an explanation is provided. Also enforces that if Initial ROM is marked 'Unable to test' or 'Not indicated', the corresponding explanation field is completed. If not, the submission should fail validation because missing rationale undermines the adequacy of the exam.
11
Active ROM Numeric Range and Unit Validation
Ensures all entered Active ROM endpoints are numeric degree values and within physiologically plausible bounds (e.g., not negative; not exceeding reasonable maxima such as flexion/extension/lateral flexion > 90 or rotation > 120 unless explicitly justified). This prevents data entry errors (e.g., swapped units, typos) that could materially affect disability evaluation. If out of range, the system should prompt correction or require a justification note.
12
Passive ROM 'Performed' Dependency and 'Same as Active ROM' Logic
If passive ROM testing is marked 'No', requires a reason selection (medically contraindicated/testing not necessary/other) and an explanation. If passive ROM is performed and 'Same as active ROM' is checked for a movement, the numeric passive value for that movement should be blank or auto-populated to match active (but not conflict). If contradictions exist (e.g., 'Same as active' plus a different number), the form should be flagged for correction.
13
Pain Evidence and Functional Loss Comment Requirement
Validates that if 'Is there evidence of pain?' is Yes, at least one applicable context is selected (weight-bearing, nonweight-bearing, active, passive, rest). If 'Causes functional loss' is checked, a comment describing how pain causes functional loss must be provided. If these are missing, the form should be returned because pain characterization is required for an adequate musculoskeletal exam.
14
Repetitive Use Testing Consistency and Post-Test ROM Requirements
Checks that if the Veteran is able to perform repetitive use testing (Yes), then the question about additional loss after three repetitions is answered; and if additional loss is Yes, all post-test ROM endpoints are provided and are not greater than the initial ROM without explanation. Also requires at least one factor causing functional loss to be selected when additional loss is reported. If incomplete or illogical, the submission should be flagged as internally inconsistent.
15
Repeated Use Over Time / Flare-Up Estimates or Required 'Not Feasible' Explanation
If procured evidence suggests significant limitation with repeated use over time or flare-ups (Yes), requires either estimated ROM values in degrees for all movements or a specific explanation why an estimate cannot be provided, including citation/discussion of evidence as prompted. This is essential because VA requires an opinion on functional loss even when not directly observed. If neither estimates nor an adequate explanation is present, the form should fail validation for exam inadequacy.
16
Examiner Credentialing and Contact Fields: NPI, License, Signature, and Phone/Fax Format
Validates that the examiner’s signature, printed name/title, specialty, date signed, and address are present, and that NPI is a 10-digit number and medical license includes a license identifier plus a state. Phone/fax numbers should match an accepted phone format and contain sufficient digits for contact. If these fields are missing or malformed, the submission should be rejected because VA must be able to authenticate the provider and contact them for clarification.
Common Mistakes in Completing VA DBQ - Neck (Cervical Spine) Conditions
People often leave the header fields blank or enter identifiers that don’t match the Veteran’s records (e.g., nickname, transposed SSN digits, or missing date of exam). This creates administrative delays because VA cannot reliably link the DBQ to the correct claim file. Always enter the Veteran’s full legal name, the correct SSN (or required identifier per your workflow), and the exact examination date in a consistent format.
The requestor section is frequently skipped or “Third party” is checked without listing the organization/individual. This can raise authenticity questions and trigger follow-up requests for clarification. Check exactly one requestor option and, if “Third party” is selected, provide the full name(s) of the organization(s) or individual(s) as requested.
A common error is marking “Was the Veteran examined in person? No” but leaving the “how was the examination conducted?” line blank, or providing answers that conflict with the rest of the exam findings. VA may discount the probative value of the DBQ if the exam method is unclear. If not in-person, clearly document the modality (telehealth/video/records review) and ensure the objective testing sections reflect what was actually performed.
Clinicians often check “Records reviewed” but fail to identify which records and the date range, or they check “No records were reviewed” despite referencing imaging or prior notes later. This undermines credibility and can lead to requests for addenda. List the specific sources (e.g., STRs, VA treatment records, private ortho notes) and the approximate date range reviewed, and keep it consistent with the narrative and diagnostic testing sections.
It’s common to select diagnoses but leave ICD codes and diagnosis dates blank, or to check “no current diagnosis” without explaining why in Remarks. Missing details can prevent VA from properly characterizing the condition and may delay rating. Provide ICD codes when available, include an approximate diagnosis date (even if based on history/records), and use Remarks to reconcile differences from prior diagnoses or to justify “no diagnosis” findings.
Many submissions use vague statements like “has flare-ups” or “pain with activity” without frequency, duration, triggers, alleviating factors, severity, and functional impact. VA relies on these specifics to evaluate functional loss, especially when flare-ups aren’t observed during the exam. Document the Veteran’s description with concrete details (how often, how long, what activities worsen it, what helps, and what they cannot do during a flare).
A frequent data-entry issue is recording ROM in percentages, writing “WNL” instead of degrees, swapping left/right rotation or lateral flexion, or entering values that exceed the listed normal endpoints (e.g., rotation > 80°) without explanation. These errors can invalidate the ROM section and prompt re-examination. Always record numeric degrees for each movement, double-check left vs right fields, and explain any atypical values or testing limitations.
The form specifically asks for pain on active vs passive motion and weight-bearing vs nonweight-bearing, but people often only document one type or forget to explain why testing wasn’t performed. Missing this information can lead to an inadequate exam determination. If you cannot perform a required test, select the appropriate reason (e.g., medically contraindicated) and provide a clear, case-specific explanation; otherwise, document pain findings for each requested condition.
Examiners commonly skip the estimated ROM after repeated use over time or during flare-ups when not directly observed, or they provide a generic statement that an estimate is not possible. VA guidance expects an estimate based on procurable information (Veteran statements, records, clinical judgment) or a detailed explanation why it’s not feasible in this specific case. Provide degree estimates when possible and, if not, cite what information was considered and why it still cannot support an estimate.
Many people mark “Yes” for incapacitating episodes based solely on the Veteran’s report of staying in bed, but the form requires bed rest prescribed by a physician and treatment by a physician. Overstating this can lead to credibility issues or denial of that component of the rating. Only check “Yes” if there is documentation or clearly identified medical records supporting prescribed bed rest, and list the dates, facility/provider, and treatment details.
A common mistake is indicating radicular symptoms but not completing all required subsections (7A–7D), especially failing to identify the involved nerve roots and laterality. This can prevent VA from assigning the correct neurologic evaluation. If radiculopathy is present, complete symptom severity for each extremity, specify C5/C6, C7, and/or C8/T1 involvement with right/left/both, and explain the likely cause of abnormal neuro findings.
DBQs are often returned because the signature block is incomplete—missing printed name/title, specialty, NPI, license number/state, or date signed. VA may question authenticity or be unable to verify the examiner, delaying adjudication. Ensure all certification fields are completed legibly and consistently, including credentials (MD/DO/NP/PA-C), specialty, NPI, license/state, address, and the date of signature.
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