Blood and Lymphatic Conditions DBQ explained

What this DBQ covers

This questionnaire groups several blood and lymphatic disorders but gives them distinct clinical sections. It includes anemia, platelet-related conditions, leukemia, multiple myeloma, lymphomas and other listed diagnoses. Laboratory findings, treatment and current status help explain the condition beyond its name. A blood-count abnormality and an established blood disorder are not necessarily the same finding.

The important sections, explained

The diagnosis determines which section applies

The anemia and thrombocytopenia section separates several blood disorders and their treatment status. Other sections address leukemia, lymphomas and additional diagnoses. Low blood counts do not identify every cause by themselves. Bring the hematology assessment and relevant testing so the clinician can select the correct section. If a blood problem developed during treatment for another condition, preserve that sequence rather than presenting the laboratory result as an unrelated established disease.

Read the official form: page 3

Active treatment, follow-up and residual effects

The condition-specific sections ask about disease status and the type or frequency of care. A past diagnosis, ongoing treatment and follow-up after treatment are different parts of the history. Treatment summaries, transfusion records or other relevant procedure notes can clarify what actually occurred. Describe current fatigue, infections or activity limitations as experienced, while leaving attribution to the clinician. An old treatment record should not silently stand in for the current disease status.

Read the official form: page 6

How to prepare useful information

Collect the specialist's diagnosis and interpretation alongside laboratory, pathology or marrow reports. Include treatment dates and follow-up that distinguish active treatment from observation or a later phase of care. Describe actual symptoms and activity limitations without assigning them to a diagnosis yourself. The clinician can assess which effects are related to the condition or its treatment and whether additional documentation is needed.

Records to gather

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

• Hematology or oncology notes and the relevant laboratory, pathology or marrow reports.
• Dated treatment records, transfusions or admissions when applicable.
• Follow-up establishing current status and descriptions of symptoms affecting daily activities.

A detail that is easy to miss

Use the full diagnosis name from the specialist record rather than a broad phrase such as blood cancer or low iron when more specific information is available. Keep test dates and treatment dates visible. If you received transfusions or other repeated care, bring records of the actual events instead of estimating a lifetime total for a question about a shorter period.

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 3
3. SECTION 3 - ANEMIA AND THROMBOCYTOPENIAPage 3
4. SECTION 4 - LEUKEMIA, MULTIPLE MYELOMA, MONOCLONAL GAMMOPATHY OF UNDETERMINED SIGNIFICANCE (MGUS), AGRANULOCYTOSIS, ACQUIRED, ESSENTIAL THROMBOCYTHEMIA, PRIMARY MYELOFIBROSIS, AND MYELODYSPLASTICPage 6
5. SECTION 5 - LYMPHOMAS, POLYCYTHEMIA VERA, AND SOLITARY PLASMACYTOMAPage 9
6. SECTION 6 - OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS, SYMPTOMS, AND SCARSPage 10
7. SECTION 7 - DIAGNOSTIC TESTINGPage 11
8. SECTION 8 - FUNCTIONAL IMPACTPage 11
9. SECTION 9 - REMARKSPage 12
10. SECTION 10 - 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

Does an abnormal blood count establish a specific blood disorder?

Not by itself. The clinician needs to interpret the result with the history and other diagnostic evidence. Bring the dated report and related specialist notes. The questionnaire has separate disease sections because similar laboratory abnormalities can have different explanations and treatment implications.

How should I organize repeated treatments or transfusions?

List the dates and type of care from the actual treatment records where available. Keep different therapies separate and identify the reason documented for each. The examiner can then apply the condition-specific questions and time periods without confusing routine monitoring with a treatment event.

Should I include records from a period of remission?

Yes, current follow-up can clarify disease status and any remaining effects. Include the earlier treatment history where relevant as well. The examiner should be able to distinguish the past active period from the findings and care that apply now.