Seizure Disorders and Epilepsy DBQ explained

What this DBQ covers

This questionnaire records a diagnosed seizure disorder, the types and frequency of episodes, treatment, and functional effects. It asks the clinician to distinguish different clinical events, which may not all look like a convulsive seizure. Loss of consciousness or an unexplained spell is not automatically epilepsy. Medical evaluations and accurate descriptions of witnessed events help the clinician characterize what occurred and how it fits the diagnosis.

The important sections, explained

What happened and who observed it

The history section asks about confirmation of the diagnosis and witnessed seizures. Describe your recollection and identify any observer's account separately, especially when awareness was impaired. Include what occurred before the event, the observed behavior and recovery. The clinician determines the seizure type and whether an event fits the diagnosed disorder. A fainting spell, a lapse in awareness and a convulsive event should not be treated as identical without medical assessment.

Read the official form: page 2

Type, frequency and the requested period

The seizure-activity section has separate questions for different types and frequencies. A dated event record can help, but the counts need to match the type and time period being assessed. Include treatment changes and relevant neurology or emergency records. Do not count every symptom in one event as a separate seizure. If the exact number is uncertain, explain the estimate and its basis rather than converting an incomplete record into a precise total.

Read the official form: page 3

How to prepare useful information

Bring neurology records, relevant testing, medication information, and a dated episode log if available. Witness accounts can describe observable facts such as movement, awareness, duration, and recovery without trying to diagnose the event. Include any documented restrictions and actual effects on daily activities or work. Continue following your treatment plan; do not stop medication or attempt to trigger an episode for an examination.

Records to gather

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

• Neurology records and relevant EEG or other existing test results
• Dated episode records and factual witness descriptions
• Medication history and documented activity restrictions or work effects

A detail that is easy to miss

A calendar total without episode descriptions may combine different events. Keep the clinician's diagnosis, witnessed observations and uncertain episodes identifiable. Include whether the event occurred before or after a treatment change. Do not stop seizure medication or attempt to trigger an episode for documentation; treatment and safety remain directed by your healthcare provider.

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 - FINDINGS, SIGNS AND SYMPTOMSPage 3
4. SECTION IV - TYPE AND FREQUENCY OF SEIZURE ACTIVITYPage 3
5. SECTION V - OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS, SYMPTOMS, AND SCARSPage 5
6. SECTION VI - DIAGNOSTIC TESTINGPage 6
7. SECTION VII - FUNCTIONAL IMPACTPage 6
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

What should a witness record about an episode?

Useful details include the date, approximate duration, what the person did or could respond to, and what recovery looked like. The witness should distinguish observations from assumptions. The clinician uses that account with the medical record to assess the event's nature and frequency.

What if I cannot remember the event itself?

Explain that gap. A witness's firsthand description and relevant medical record can add information about the event, while you describe what you remember before and after. The clinician evaluates the combined evidence; you should not fill missing details with guesses.

Should I label events as major or minor myself?

Describe the actual event and use established clinical records when available. The form's categories require the examiner's assessment. A simple label may omit important details about awareness, movement and recovery or group events that the clinician would distinguish.