Va 10 questionnaire form 2026

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The document is a Disability Benefits Questionnaire (DBQ) for veterans applying for disability benefits related to peripheral nerve conditions, excluding diabetic sensory-motor peripheral neuropathy. It outlines the necessary information required from the physician regarding the veteran's diagnosis, medical history, symptoms, muscle strength testing, reflex exams, sensory exams, and functional impact of the condition. The form emphasizes that the Department of Veterans Affairs will not reimburse any costs incurred in completing it and includes privacy notices regarding the handling of personal information.

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Click ‘Get Form’ to open the va 10 questionnaire form in the editor.
Begin by entering the patient/veteran's name and social security number at the top of the form. This information is crucial for identification purposes.
In Section I, diagnose any peripheral nerve conditions. Answer 'Yes' or 'No' to whether the veteran has a condition, and if 'Yes', provide relevant diagnoses along with ICD codes and dates.
Proceed to Section II to summarize the medical history of the veteran's condition, including onset and course. Indicate which hand is dominant.
In Section III, check all applicable symptoms related to peripheral nerve conditions, specifying severity for each extremity.
Continue through Sections IV to XII, filling out muscle strength testing, reflex exams, sensory exams, and any assistive devices used by the veteran.
Finally, ensure that all sections are completed accurately before submitting. Review your entries for clarity and completeness.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (180 Votes)
2010	3.7 Satisfied (35 Votes)

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When to use VA form 21 10210?

When to use this form. Use VA Form 21-10210 to submit a formal statement to support your VA claimor the claim of another Veteran or eligible family member. People also sometimes call this statement a buddy statement.