What this DBQ covers
Part A is the service member's account of medical history and current concerns. Unlike the condition-specific clinician DBQs in this library, it asks you to supply information yourself. The identification and medical-history sections help organize what the examiner needs to discuss. Review each question carefully, including earlier injuries, treatment and continuing symptoms. A past problem that resolved and a problem that still affects you should not be described as though they are the same.
The important sections, explained
Your history and the time period
The medical-history questions do not all cover the same time period. Some concern the past month or year, while others ask whether something has ever happened. Read that wording before answering. A surgery from several years ago may belong in a lifetime history even if it causes no current problem. When a question asks about present limitations, explain what still affects you now and distinguish that from the earlier episode.
Read the official form: page 2
Care outside the military system
Part A asks about care outside military facilities and illnesses or injuries for which you did not seek care. Those questions give you a place to explain history that may be missing from your service treatment records. Identify the facility, approximate date and reason for care where you can. If there is no record, describe what you personally remember and make the uncertainty clear. The examining clinician can then decide what needs further discussion or evaluation.
How to prepare useful information
Work through your service treatment records and personal recollection together. Note approximate dates when you cannot remember an exact date, identify where treatment occurred, and explain any ongoing effects in ordinary language. The self-assessment is a starting point for the separation health review, not a medical diagnosis or a completed compensation claim. Discuss uncertainty with the examiner rather than filling a gap with a guess.
Fictional example
A separating service member remembers an ankle injury during training but is unsure of the month. They describe the approximate training period, say they did not attend sick call, and explain that uneven ground still causes difficulty. They also list a later civilian clinic visit separately. This preserves the difference between recollection and documented treatment without inventing a precise date or diagnosis.
Records to gather
Start with records you already have. Bring the relevant information to your clinician and explain any gaps or uncertain dates.
- Service treatment records and profiles that help reconstruct injuries, symptoms and restrictions.
- Medication and treatment history, including care outside military facilities.
- A factual list of current concerns with approximate onset dates and any continuing limitations.
A detail that is easy to miss
Do not assume that an old questionnaire has every current concern on it. Compare your answers with later appointments, new medications and changes since your last assessment. Check each requested time period, and mention relevant treatment that occurred outside the military record system. A copied answer may be accurate historically but incomplete for the separation examination.
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.
Who completes Part A?
Part A is the service member's self-assessment. Answer its history questions accurately and follow the official instructions for your separation process. It is distinct from the clinical assessment in Part B, which VA does not list as a public download.
Use existing records to help with dates and history. An answer on a self-assessment does not replace a clinician's diagnosis or establish a benefit decision by itself.
Common questions
Do I complete the Separation Health Assessment myself?
Part A is the self-assessment portion. Follow the form's instructions and the instructions from your separation program. VA lists Part B separately among questionnaires unavailable for public use. Completing Part A does not replace the clinician's examination or the other steps required for your claim.
What if I cannot remember an exact treatment date?
Use an approximate date or period and identify it as approximate. A deployment, duty station or training event may help place the event in time. Do not turn an uncertain memory into an exact date just to fill the space; discuss it during the examination.
Should I list an injury that was never treated?
Part A includes a question about injuries or illnesses for which you did not seek medical care. Answer that question truthfully and explain the event and any continuing effects. Reporting it gives the clinician information to assess; it does not by itself establish a diagnosis or a compensation award.
Official source and editorial approach
This is Claim Raven's plain-language guide, separate from the official questionnaire. The explanation and checklist were prepared from the linked form. They help you understand and organize information; they are not an assessment of your individual claim.
Separation Health Assessment DBQ - Part A: official VA PDF
Printed revision: 2026-06-02 ~v26_3
Source checked: September 9, 2026
Source verification details
SHA-256 of the PDF checked for this guide:171c07253c62b1d8e48463ba98bec9e76a98990db9d77e8054f7e6392d97c870