Diabetic Peripheral Neuropathy DBQ explained

What this DBQ covers

This questionnaire addresses peripheral neuropathy identified as diabetic. It records symptoms and examination findings in the arms and legs, including strength, reflexes, and sensation, and asks the clinician to assess the affected nerves. Diabetes and numbness appearing in the same record do not automatically establish that every nerve symptom is caused by diabetes. The medical assessment should explain the diagnosis and distinguish other possible or coexisting conditions.

The important sections, explained

Which limbs and symptoms are involved

The symptom section separates findings in the upper and lower extremities. Describe pain, tingling, numbness or other changes by limb and location, including whether both sides differ. A diabetes diagnosis alone does not establish that every sensory complaint is diabetic neuropathy. Bring the record supporting the neuropathy diagnosis and any relevant nerve testing. The clinician assesses the relationship and determines which symptoms are attributable to the condition being evaluated.

Read the official form: page 2

Neurological testing and severity

The neurological examination includes clinical findings that support the later severity assessment. Your history adds context about walking, balance, handling objects and other activities. Explain what happens and how often, rather than selecting mild, moderate or severe based only on how distressing the symptom feels. Clinical severity combines the relevant findings and judgment. If joint pain or another nerve condition also affects function, describe it separately so the overlap remains visible.

Read the official form: page 3

How to prepare useful information

Bring diabetes care records, neurological evaluations, and nerve testing if it has already been performed. Describe where pain, tingling, numbness, or weakness occurs and how it affects walking, balance, handling objects, or other tasks. Mention changes over time and relevant treatment. The clinician should record the right and left findings separately and determine how the symptoms relate to the diagnosed neuropathy.

Records to gather

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

• Records identifying diabetic neuropathy and relevant diabetes history
• Neurological examinations and existing nerve-conduction or EMG results
• Examples of affected walking, balance, grip, or fine hand movements

A detail that is easy to miss

Do not treat both sides as identical merely because symptoms occur in both feet or hands. Explain differences in location and practical effect. Keep a prior nerve-study report dated and include newer relevant follow-up. If symptoms began before diabetes was diagnosed, say so; the clinician needs an accurate timeline to assess attribution rather than a simplified story.

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 1 - DIAGNOSISPage 1
2. SECTION 2 - MEDICAL HISTORYPage 2
3. SECTION 3 - SYMPTOMSPage 2
4. SECTION 4 - NEUROLOGIC EXAMPage 3
5. SECTION 5 - SEVERITYPage 5
6. SECTION 6 - ASSISTIVE DEVICESPage 6
7. SECTION 7 - REMAINING EFFECTIVE FUNCTION OF THE EXTREMITIESPage 7
8. SECTION 8 - OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS, SYMPTOMS, AND SCARSPage 7
9. SECTION 9 - DIAGNOSTIC TESTINGPage 8
10. SECTION 10 - FUNCTIONAL IMPACTPage 8
11. SECTION 11 - REMARKSPage 9
12. SECTION 12 - EXAMINER'S CERTIFICATION AND SIGNATUREPage 9

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 every nerve symptom in a person with diabetes diabetic neuropathy?

No. Other conditions can cause or contribute to nerve symptoms. Give the clinician the full history and relevant records so the diagnosis and affected nerves can be assessed. The questionnaire is intended to document the medically identified diabetic neuropathy, not assume the cause.

Is this the same as the general peripheral nerves DBQ?

This form specifically addresses diabetic peripheral neuropathy. VA also provides a general peripheral nerves questionnaire. The appropriate form depends on the diagnosed condition and medical attribution, not simply whether a veteran with numbness also happens to have diabetes.

Do I need to choose a severity label?

No. Describe your actual symptoms and limitations and let the examiner assess severity using the clinical findings. A symptom diary or task example can provide context, but it should not be used to assign a nerve rating or paralysis category independently.