Esophageal Disorders and GERD DBQ explained

What this DBQ covers

This questionnaire covers disorders of the esophagus, the passage between the throat and stomach. It includes GERD and hiatal hernia, while also asking about other diagnoses, symptoms, treatment requirements and procedures. Some findings require particular medical evidence, such as a pathology report. Describing every upper digestive symptom as reflux can leave out information the clinician needs to assess swallowing or other problems.

The important sections, explained

Swallowing problems and procedures

The signs-and-symptoms section asks about esophageal conditions, including GERD and hiatal hernia, and relevant treatment requirements. Some questions concern narrowing of the esophagus and procedures used to treat it. Describe whether difficulty occurs with solids, liquids or both, what happens during meals and how often it occurs. The clinician uses the medical record to identify the cause; trouble swallowing alone does not establish that a particular type of narrowing is present.

Read the official form: page 3

Testing and the treatment timeline

Endoscopy, pathology and procedure reports can explain findings that a prescription list does not. The form has specific questions about Barrett's esophagus, procedures and complications after treatment. Keep the report, procedure date and subsequent care connected. If you changed food texture or eating habits, explain whether that came from clinical advice or your own response to symptoms. The distinction helps the examiner understand both documented treatment and your day-to-day experience.

Read the official form: page 6

How to prepare useful information

Organize the history of medication, procedures and continuing symptoms. Explain whether a problem occurs with eating, swallowing, lying down or another activity, and identify any documented complications after surgery. Bring existing endoscopy, pathology or imaging reports when relevant. The clinician should interpret the findings and complete the appropriate section; you do not need to translate symptoms into a medical severity category yourself.

Records to gather

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

• Gastroenterology notes, relevant endoscopy or pathology reports and the diagnosis history.
• Prescribed treatment and records of procedures, surgery or subsequent complications.
• A factual account of swallowing or reflux symptoms and their effect on eating and ordinary activities.

A detail that is easy to miss

Do not rely on an old online GERD checklist as a substitute for the current questionnaire. Use the questions in the linked source and bring the actual reports supporting your history. A medication can show treatment but may not establish the diagnosis, procedure frequency or present swallowing difficulty. Note changes after a procedure as well as symptoms beforehand.

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 3
3. SECTION III - SIGNS AND SYMPTOMSPage 3
4. SECTION IV - TUMORS AND NEOPLASMSPage 5
5. SECTION V - OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS AND OR SYMPTOMS, AND SCARSPage 6
6. SECTION VI - DIAGNOSTIC TESTINGPage 6
7. SECTION VII - FUNCTIONAL IMPACTPage 7
8. SECTION VIII - REMARKSPage 7
9. SECTION IX - EXAMINER'S CERTIFICATION AND SIGNATUREPage 7

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 GERD documented on the general hernia DBQ?

VA's current esophageal questionnaire explicitly includes GERD and hiatal hernia. The separate hernia questionnaire addresses abdominal wall, inguinal, femoral and other listed hernias. The location and diagnosis determine which form is appropriate; the word hernia alone does not identify the right questionnaire.

Should I mention changes in food texture?

Yes. Explain which textures are difficult, what happens when you eat them and whether a clinician directed the change. Bring any swallowing assessment or treatment instructions. The examiner distinguishes your practical adaptations from documented medical treatment requirements and determines the relevant findings.

Should I include a procedure even if it helped?

Yes. Describe when it occurred, what it treated and what improved or remained afterward. A successful treatment is part of an accurate history. The clinician needs the current findings and the treatment course, not only evidence of symptoms at their worst.