Amyotrophic Lateral Sclerosis (ALS) DBQ explained

What this DBQ covers

The ALS questionnaire documents a progressive neurological condition and the ways it affects different functions. Relevant findings may involve movement, speech, swallowing, breathing, and the ability to carry out daily activities. The form helps organize those effects rather than reducing the condition to a single symptom. It also includes questions about assistance and care needs, which should reflect the person's actual circumstances and the clinician's assessment.

The important sections, explained

Effects across more than one body system

The ALS questionnaire covers muscle weakness and other possible effects involving swallowing, breathing, bowel or bladder function and additional systems. A diagnosis does not mean every listed finding is present. Bring relevant specialist and therapy records, and describe changes in daily function with dates where possible. The clinician identifies which effects are attributable to ALS and which remain uncertain. This broader history helps avoid reducing a complex condition to walking difficulty alone.

Read the official form: page 2

Help with daily activities

The aid-and-attendance sections ask about assistance needs, including whether a higher level of skilled care is required. Describe the actual task, the help received, who provides it and how often. Assistance with a transfer, meal preparation and skilled medical care are different needs. The clinician documents the relevant findings; the form is not an instruction to choose a benefit level. Include existing care plans so the description reflects the current support arrangement.

Read the official form: page 9

How to prepare useful information

Bring neurology records, treatment updates, and any assessments of breathing, swallowing, communication, mobility, or daily care. A caregiver's factual account can help describe tasks requiring assistance, how often help is needed, and what equipment is used. Separate what the person can do independently from activities requiring support. The clinician should explain the medical findings and care needs; the completed form itself does not decide entitlement to a particular benefit.

Records to gather

Start with records you already have. Bring the relevant information to your clinician and explain any gaps or uncertain dates.

• Neurology records confirming the diagnosis and describing progression
• Therapy and respiratory or swallowing evaluations, where applicable
• Current equipment, daily assistance, and prescribed care records

A detail that is easy to miss

Do not assume an older mobility assessment still describes current function if needs have changed. Include recent care and equipment updates where available. Preserve what can be done independently as well as where help is needed. A caregiver should identify firsthand observations and avoid supplying medical conclusions or attributing every symptom to ALS without the clinician's assessment.

Find your way around the official form

These section headings come from the linked VA PDF. Each link opens the page where the section begins. Read the form's own instructions for the full questions and any required attachments.

1. SECTION I - DIAGNOSISPage 1
2. SECTION II - MEDICAL HISTORYPage 2
3. SECTION III - CONDITIONS, SIGNS AND SYMPTOMS DUE TO ALSPage 2
4. SECTION IV - NEUROLOGIC EXAMPage 6
5. SECTION V - OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS AND/OR SYMPTOMSPage 8
6. SECTION VI - MENTAL HEALTH MANIFESTATIONS DUE TO ALS OR ITS TREATMENTPage 8
7. SECTION VII - HOUSEBOUNDPage 8
8. SECTION VIII - AID AND ATTENDANCEPage 9
9. SECTION IX - NEED FOR HIGHER LEVEL (i.e., more skilled) AID & ATTENDANCE (A&A)Page 9
10. SECTION X - ASSISTIVE DEVICESPage 10
11. SECTION XI - REMAINING EFFECTIVE FUNCTION OF THE EXTREMITIESPage 10
12. SECTION XII - FINANCIAL RESPONSIBILITYPage 11
13. SECTION XIII - DIAGNOSTIC TESTINGPage 11
14. SECTION XIV - FUNCTIONAL IMPACTPage 11
15. SECTION XV - REMARKSPage 12
16. SECTION XVI - EXAMINER'S CERTIFICATION AND SIGNATUREPage 12

Who completes the clinical sections?

The healthcare provider completes the clinical assessment, identifies the records reviewed, and signs the questionnaire. You can gather records and describe symptoms and daily limitations. Measurements, diagnoses, and clinical conclusions belong to the examiner.

Check the official form's instructions with your provider before the appointment, including any examination or testing requirements. VA does not pay or reimburse the costs of having a private DBQ completed or submitted.

A completed DBQ can help document the medical condition. Whether it also answers a particular service-connection question depends on its content and the other evidence. VA may verify the form or request another examination.

Common questions

Should assistance needs be included even if a caregiver manages them well?

Yes. Describe the help actually needed, including tasks, frequency, and who provides it. Successful support can make a limitation less visible during a brief visit. The clinician can use that history and the medical evidence to document the underlying functional needs accurately.

Can a caregiver help explain the daily routine?

A caregiver can provide relevant observations about tasks and assistance they personally know, with the veteran's participation as appropriate. Identify who is describing each fact. The clinician evaluates the medical findings and care needs rather than treating a caregiver's account as a diagnosis.

Does this DBQ automatically award aid and attendance?

No. It includes medical questions about assistance and skilled-care needs, but VA determines eligibility under the applicable benefit rules. Accurate examples and care records help the examiner document the needs without promising a particular award.