EXERTION QUESTIONNAIRE SINCE YOUR DISABILITY BEGAN 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling in your personal information at the top, including your name and case number.
  3. For question 1, select your current living situation by circling the appropriate option. If you choose 'Other', provide a brief explanation.
  4. In question 2, indicate who you live with by circling the relevant choice. Again, explain if you select 'Other'.
  5. Questions 3 through 20 require detailed responses about your daily activities and how your condition affects them. Take your time to provide specific examples for clarity.
  6. Ensure that you sign and date the form at the end before submitting it.

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The Adult Function Report is often used by Social Security to discredit your claim. The ten-page form asks about your daily activities, personal care, meal prep, household and yard work, hobbies, and social activities.
Although any civilian provider can complete a Public DBQ, its often best to have a physician complete a DBQ. The VA holds a higher view of DBQs filled out by physicians. Also, even if you submit a Disability Benefits Questionnaire as evidence prior to your CP exam, your examiner will still complete one at your exam.
What Questions Are Asked at a SSDI Hearing? Personal Background Questions. Work Background Questions. Medical Issues Questions. Specific Activity Limitation Questions (If Applicable) Questions About Activity Limitations Arising From Non-Physical Problems (Mental Health or Pain)
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Tips to Improve Your Chances of Getting Disability Benefits File Your Claim as Soon as Possible. Make an Appeal within 60 Days. Provide Full Details of Medical Treatment. Provide Proof of Recent Treatment. Report your Symptoms Accurately. Provide Medical Evidence. Provide Details of your Work History.
How to Answer Disability Questionnaires Write clearly and legibly. Avoid erasures as much as possible. Do not leave any section of the form blank (unless otherwise specified). Give consistent answers. Answer the questions truthfully. Follow the instructions on the form.
5 Things Not to Say in a Disability Interview No one will hire me; I cant find work. I am not under medical treatment for my disability. I have a history of drug abuse or criminal activity. I do household chores and go for walks. My pain is severe and unbearable. Legal Guidance When SSDI Benefits Are Denied.
When your conditions became disabling: Dates you last worked; The names, addresses, phone numbers, and dates of visits to your doctors; The names of medications that you take and medical tests youve had; and. Marital information.
Write down the specific things you have difficulty doing such as walking, getting out of a chair, or moving about in some other way. Next, describe the symptom or problem that specifically limits yousuch as weakness or paralysis, numbness, pain, poor balance, dizziness, or lack of coordination.

ssa pain questionnaire