Stomach and Duodenum Conditions DBQ explained

What this DBQ covers

This questionnaire addresses stomach and duodenal conditions, including peptic ulcer disease, chronic gastritis, injury and complications of certain operations. It has separate sections for different surgical histories and resulting problems. That structure helps the clinician distinguish the original disease from effects of treatment and from conditions assessed on another digestive questionnaire.

The important sections, explained

Stomach disease and injury

The questionnaire distinguishes ulcer disease, chronic gastritis and other stomach conditions from stomach injury. Describe the location, timing and pattern of symptoms, including their relationship to meals when you have noticed one. A general term such as indigestion does not identify the diagnosis by itself. Endoscopy, imaging, laboratory and specialist reports may help explain what has been established. The clinician decides which findings fit the relevant stomach or duodenal condition.

Read the official form: page 3

Effects after upper digestive surgery

The surgery sections address procedures involving the stomach or duodenum and complications afterward. Postgastrectomy refers to the period after removal of stomach tissue. The operation report helps identify the procedure, while follow-up records describe what remains. Include medically directed diet changes, nutritional care and medication where relevant. Separate the symptoms that led to surgery from those occurring afterward so the examiner does not have to infer whether treatment improved or changed the problem.

Read the official form: page 4

How to prepare useful information

Bring the exact diagnosis and procedure records when available. Everyday terms such as stomach trouble may describe several different parts of the digestive system. Explain symptoms in relation to meals, treatment and activity, and include any documented complications after surgery. The clinician should determine the condition and applicable section rather than relying on the broad word stomach to choose a diagnosis.

Records to gather

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

• Endoscopy, laboratory or specialist records supporting the stomach or duodenal diagnosis.
• Operative reports identifying the procedure and follow-up for any complications.
• A timeline of symptoms, prescribed treatment and effects on eating or ordinary activities.

A detail that is easy to miss

Do not assume that GERD, an ulcer and a stomach-surgery complication use identical questions. Match the diagnosis to the appropriate form and section. If several digestive conditions coexist, label the supporting reports. A medication list alone may not establish an ulcer or explain the anatomy after surgery, so include the relevant diagnostic and operative records when available.

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 - PEPTIC ULCER DISEASE, CHRONIC GASTRITIS, OR OTHER STOMACH CONDITIONSPage 3
4. SECTION IV - STOMACH INJURYPage 3
5. SECTION V - COMPLICATIONS OF UPPER GASTROINTESTINAL SURGERY AND POSTGASTRECTOMY SYNDROMEPage 4
6. SECTION VI - VAGOTOMY WITH PYLOROPLASTY OR GASTROENTEROSTOMYPage 5
7. SECTION VII - TUMORS AND NEOPLASMSPage 5
8. SECTION VIII - OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS AND/OR SYMPTOMSPage 6
9. SECTION IX - DIAGNOSTIC TESTINGPage 6
10. SECTION X - FUNCTIONAL IMPACTPage 7
11. SECTION XI - REMARKSPage 8
12. SECTION XII - EXAMINER'S CERTIFICATION AND SIGNATUREPage 8

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 this form also replace the GERD questionnaire?

Not automatically. VA's esophageal disorders DBQ specifically includes GERD and hiatal hernia, while this form focuses on stomach and duodenal conditions. A clinician should choose the form or forms that match the diagnoses and findings. Similar digestive symptoms can require different documentation.

How should I explain eating changes after stomach surgery?

Describe the present meal routine, symptoms during or after eating and any clinician-directed diet or nutritional treatment. Bring the operation and follow-up records. Identify what changed after the procedure rather than assuming every eating difficulty was present before surgery or has the same cause.

Should I report weight changes from before treatment?

Relevant dated measurements can help describe the course, especially when your clinician evaluated them. Distinguish earlier changes from your current weight and nutrition. Avoid estimating medical significance yourself; bring the records so the examiner can interpret the pattern in context.