Artery and Vein Conditions DBQ explained

What this DBQ covers

This questionnaire covers several different blood-vessel conditions. Its separate sections distinguish problems with veins from arterial disease, aneurysms, Raynaud's disease or syndrome and other vascular disorders. That separation matters because swelling, color changes, pain and reduced circulation do not all mean the same thing. The clinician records the diagnosed condition and the applicable findings, then documents testing, treatment and functional effects.

The important sections, explained

Which circulation problem is being described?

The vein and arterial sections ask about different findings. For vein problems, the form addresses symptoms such as swelling and skin changes. For arterial disease, it asks about the diagnosed disorder and relevant treatment or procedures. Tell the clinician which side is affected and whether symptoms change with standing, walking or resting. A problem in the left leg should not silently become a finding for both legs when the form is completed.

Read the official form: page 3

Procedures and present function

Diagnostic testing and the functional-impact section connect the medical history with present limitations. A past vascular procedure is useful context, but the clinician also needs to know what symptoms remain after it. Bring the report with its date and the name of the procedure if available. Describe how far or how long you can perform an ordinary activity before symptoms change, while leaving interpretation of circulation measurements and the cause of those symptoms to the clinician.

Read the official form: page 9

How to prepare useful information

Describe which limb or body area is affected, what brings on symptoms, how long they last and what changes with rest or treatment. If your history includes a vascular procedure, an ulcer or an amputation, provide the relevant records so the clinician can connect the present findings with that history. The form's many sections are not a checklist of conditions you should select; only the sections that apply to the clinical findings should be completed.

Records to gather

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

• Vascular clinic notes and dated circulation studies, including the side tested.
• Records of compression treatment, procedures, ulcers or wound care when applicable.
• Notes describing walking or standing limits, swelling patterns and changes with treatment.

A detail that is easy to miss

A surgery name alone can leave the reader unsure which vessel or limb was treated. Match procedure records with the side, date and reason for treatment. Include follow-up notes when the current symptoms differ from those before surgery. If pain has several possible causes, describe it without assuming that every walking limitation comes from the vascular condition.

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 - VARICOSE VEINS AND/OR POST- PHLEBITIC SYNDROMEPage 3
4. SECTION IV - PERIPHERAL ARTERIAL DISEASE AND THROMBO-ANGIITIS OBLITERANS (BUERGER'S DISEASE)Page 3
5. SECTION V - ANEURYSM, ANY LARGE ARTERYPage 4
6. SECTION VI - AORTIC ANEURYSM: ASCENDING, THORACIC, OR ABDOMINALPage 4
7. SECTION VII - ANEURYSM OF A SMALL ARTERYPage 4
8. SECTION VIII - RAYNAUD'S DISEASE OR SYNDROMEPage 5
9. SECTION IX - ARTERIOVENOUS (AV) FISTULA, ANGIONEUROTIC EDEMA OR ERYTHROMELALGIAPage 5
10. SECTION X - TUMORS AND NEOPLASMSPage 6
11. SECTION XI - AMPUTATION AND ASSISTIVE DEVICESPage 8
12. SECTION XII - OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS, SYMPTOMS, AND SCARSPage 9
13. SECTION XIII - DIAGNOSTIC TESTINGPage 9
14. SECTION XIV - FUNCTIONAL IMPACTPage 10
15. SECTION XV - REMARKSPage 10
16. SECTION XVI - EXAMINER'S CERTIFICATION AND SIGNATUREPage 10

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

Is this only a varicose veins questionnaire?

No. Varicose veins and post-phlebitic syndrome are one part of a broader vascular form. Other sections address arterial disease, aneurysms and additional diagnosed conditions. A clinician should determine which sections apply; similar symptoms do not establish that you have each listed disorder.

Should I bring an older circulation test?

An older test can help document the history, especially when it led to treatment. Label it by date and include newer relevant reports if you have them. The clinician decides which results describe the present condition and whether additional testing is appropriate.

Does this guide cover Raynaud's disease too?

The official form includes a separate Raynaud's disease or syndrome section. Use the diagnosis and findings documented by your clinician, and describe the timing and circumstances of episodes. Similar color changes or discomfort do not establish that diagnosis on their own.