Ear and Vestibular Conditions DBQ explained

What this DBQ covers

This questionnaire addresses vestibular and other ear conditions, including balance-related symptoms, infection, inflammation and surgical history. It is different from the hearing loss and tinnitus DBQ, which VA lists as unavailable for public use. Ear symptoms can overlap, but the clinician must determine which diagnosis and findings the available form should document.

The important sections, explained

Balance symptoms and ear disease

The vestibular section concerns the balance system. The next section addresses infectious, inflammatory and other ear conditions. Describe the experience precisely: spinning, unsteadiness and feeling faint are not interchangeable descriptions. Include episode length, frequency and what you were doing when it occurred. The clinician determines which symptoms fit the diagnosed ear condition. You can report what happened without deciding which part of the ear or nervous system caused it.

Read the official form: page 3

Surgery, examination and testing

The form asks about surgical treatment and any residual effects, then records the physical examination and relevant tests. A past ear operation may explain part of the history, but the examiner also needs current findings. Bring operative and follow-up notes together when available. An audiogram may be relevant background, yet this questionnaire does not replace the separate hearing-loss and tinnitus examination. Match the guide to the condition actually being evaluated with your clinician.

Read the official form: page 4

How to prepare useful information

Describe dizziness or balance episodes in concrete terms: how often they occur, how long they last and whether they affect walking or ordinary tasks. Include treatment, testing and procedure records. If hearing symptoms also occur, report them accurately without assuming this questionnaire replaces a hearing evaluation. A statement that you feel dizzy is useful history, but it does not identify the diagnosis on its own.

Records to gather

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

• Ear, nose and throat clinic notes and available vestibular testing.
• Records of ear infections, drainage, surgery and treatment when relevant.
• A dated account of balance episodes, falls or activity limitations, distinguishing reported events from clinical findings.

A detail that is easy to miss

The phrase ear problems can hide several different issues. Keep drainage, pain, balance episodes and hearing concerns identifiable rather than grouping them into one symptom. If an episode caused a fall, explain what you remember and whether anyone observed it. Do not label an episode with a medical diagnosis that has not been established in the records.

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 - VESTIBULAR CONDITIONSPage 3
4. SECTION IV - INFECTIOUS, INFLAMMATORY AND OTHER EAR CONDITIONSPage 3
5. SECTION V - SURGICAL TREATMENTPage 4
6. SECTION VI - PHYSICAL EXAMPage 4
7. SECTION VII - TUMORS AND NEOPLASMSPage 6
8. SECTION VIII - OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS, SYMPTOMS, AND SCARSPage 7
9. SECTION IX - DIAGNOSTIC TESTINGPage 8
10. SECTION X - FUNCTIONAL IMPACTPage 8
11. SECTION XI - REMARKSPage 9
12. SECTION XII - 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

Can I use this public form instead of the hearing loss and tinnitus DBQ?

They are different questionnaires. This form addresses vestibular, infectious and other ear conditions; VA separately lists hearing loss and tinnitus among forms unavailable for public use. Ask the evaluating clinician which examination is appropriate rather than treating one form as a substitute for the other.

What information helps after an ear operation?

The operation report and later ENT notes can identify the procedure and any documented remaining effects. Explain which symptoms existed before surgery and which changed afterward. The examiner can compare that timeline with the current examination instead of assuming the operation resolved every concern.

What is useful in a balance-episode log?

Record the date, approximate duration, activity and what you experienced, including any interruption or recovery. Identify estimates as estimates. The clinician can interpret that history with examination findings; a log alone does not determine the diagnosis or the medical cause of a fall.