Lifestyle Questionnaire - Department of Veterans Affairs 2026

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The document is a Lifestyle Questionnaire designed for veterans seeking an assessment of their lifestyle rating by the Department of Veterans' Affairs. It consists of five parts that gather information on personal details, relationships, mobility, recreation and community activities, and domestic and employment activities. Respondents are instructed to only report on disabilities recognized as war or defense-related. The form emphasizes the importance of providing accurate information regarding how these disabilities affect various aspects of life, while also ensuring privacy protection under relevant laws.

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Click ‘Get Form’ to open the Lifestyle Questionnaire in the editor.
Begin with PART A, where you will enter your personal details such as surname, given names, date of birth, and DVA file number. Ensure accuracy for proper identification.
Move to PART B to assess your personal relationships. Here, tick the statements that apply to you regarding how your disabilities affect your interactions with others.
In PART C, evaluate your mobility. Answer questions about any difficulties you face while walking or using transportation. Be specific about the type of assistance you may need.
Proceed to PART D, focusing on recreation and community activities. Indicate how often you engage in various social activities and note any difficulties experienced due to disabilities.
Finally, complete PART E regarding domestic and employment activities. Assess how well you can perform household tasks and provide insights into your work situation.

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Versions	Form popularity	Fillable & printable
2019	4.3 Satisfied (58 Votes)
2009	4 Satisfied (48 Votes)

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What is option 2 of the DVA lifestyle rating?

Option 2 is to be used if the claimant chooses not to self-assess or to complete a Lifestyle Questionnaire; Option 3 is to be used if the claimant completes a Lifestyle Questionnaire.

What is the impairment assessment for DVA?

An Impairment Assessment aims to determine the impact of the veterans service-related medical conditions. The forms will ask for information such as: the severity of the disease; previous and current treatment; the veterans functional status; a small number of examination findings; and common investigation results.

What questions are in a lifestyle questionnaire?

Lifestyle Surveys commonly include the following 5 key themes: Smoking. Alcohol Consumption. Physical Activity. Drug Use. Diet. General Health Status.

What is a DVA assessment?

A DVA assessment is a thorough analysis done to find out how much of a veterans illnesses or injuries are attributable to their military service. In order to determine a patients eligibility for compensation, this process entails medical examinations as well as reviews of service and medical records.

What is the DVA lifestyle rating self assessment?

Self assessment helps you to work out how your disabilities affect your life and lets you choose your own lifestyle rating. There are four parts of equal importance: personal relationships; mobility; recreational and community activities; and domestic and employment activities.

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What is a VA questionnaire?

DBQs were developed as a specific means to collect the necessary medical information required to process Veterans disability claims. DBQs provide Veterans with a way to submit medical evidence from their private health care provider to support claims for disability benefits.

What is the maximum DVA points?

All of your accepted conditions are combined to arrive at a total impairment rating on a scale from 0 to 100 points. The impairment rating is then combined with your type of service at the time of injury, along with a lifestyle rating of 0 to 7 to determine the compensation payable.

Lifestyle Questionnaire - Department of Veterans Affairs 2026

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