If you are filing your VA disability compensation claim using private health care options, you can use a DBQ form, Disability Benefits Questionnaire, to evaluate your disability.

To file a VA disability compensation claim for diabetes mellitus you need to add claims for all applicable conditions associated with your diabetes mellitus.   No matter how controlled, diabetes mellitus is a progressive disease. Diabetes Mellitus affects all systems, organs, and functions of the body and causes other conditions. You will need your Private Physician or Physicians to complete a DBQ’s for the diabetes mellitus and each related condition.

The DBQ’s for diabetes mellitus and related conditions can be viewed, filled for printing, downloaded or printed for your Doctor at website:


Or, VA DBQ Forms can be viewed, filled for printing, downloaded or printed for your Doctor at website:


The following is a list of some of the DBQ Forms related to Diabetes Mellitus. If you have another condition related that is not listed, go to the websites above and obtain the VA DBQ form associated with your condition or conditions.

  • VA-21-0960E-1  – Diabetes Mellitus
  • VA-21-0960C-4 – Diabetic Sensory-Motor Peripheral Neuropathy
  • VA-21-0960A-4 – Heart Conditions (diabetic heart disease)
  • VA-21-0960A-3 – Hypertension
  • VA-21-0960A-2 – Artery and Vein Conditions (diabetic vascular disease)
  • VA-21-0960M-1 – Amputations (diabetic vascular disease)
  • VA-21-0960N-2 – Eye Conditions (diabetic retinopathy)
  • VA-21-0960G-1 – Esophageal Conditions (diabetic reflux)
  • VA-21-0960G-7 – Stomach and Duodenal Conditions (diabetic changes)
  • VA-21-0960G-2 – Gallbladder and Pancreas (diabetic pancreatitis)
  • VA-21-0960J-1 – Kidney Conditions (diabetic kidney impairment)
  • VA-21-0960M-6 – Foot Conditions (diabetic foot drop)
  • VA-21-0960F-2 – Skin Conditions (diabetic dermatitis)
  • VA-21-0960J-2 – Male Reproductive Organ Conditions (diabetic vascular disease)
  • VA-21-0960I-5 – Nutritional Deficiencies (diabetic stomach conditions)
  • VA-21-0960L-2 – Sleep Apnea