Title of Specific Disability Benefits Questionnaires (DBQs). Form

21-0960A-1

Ischemic Heart Disease (IHD)

5/2/2013

10/2012

2

21-0960A-2

Artery and Vein Conditions (Vascular Diseases Including Varicose Veins)

9/11/2013

10/2012

5

21-0960A-3

Hypertension

9/11/2013

10/2012

2

21-0960A-4

Heart Conditions (Ischemic/Non-Ischemic Heart Disease, Arrhythmias, Valvular Disease & Cardiac Surgery)

5/2/2013

10/2012

7

21-0960B-1

Hairy Cell and Other B-Cell Leukemias

5/2/2013

10/2012

2

21-0960B-2

Hematologic and Lymphatic Conditions, Including Leukemia

5/2/2013

10/2012

4

21-0960C-1

Parkinson's Disease

5/2/2013

10/2012

2

21-0960C-2

Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease)

5/2/2013

10/2012

7

21-0960C-3

Cranial Nerve Conditions

5/7/2013

10/2012

5

21-0960C-4

Diabetic Sensory-Motor Peripheral Neuropathy

5/2/2013

10/2012

5

21-0960C-5

Central Nervous System and Neuromuscular Diseases (Except Trau. Brain Injury, etc.)

5/12/2013

10/2012

9

21-0960C-6

Narcolepsy

5/7/2013

10/2012

2

21-0960C-7

Fibromyalgia

5/7/2013

10/2012

3

21-0960C-8

Headaches (Including Migraine Headaches)

5/2/2013

10/2012

3

21-0960C-9

Multiple Sclerosis (MS)

5/2/2013

10/2012

9

21-0960C-10

Peripheral Nerves Conditions (Not Including Diabetic Sensory-Motor Peripheral Neuropathy)

5/2/2013

10/2012

8

21-0960C-11

Seizure Disorders (Epilepsy)

5/7/2013

10/2012

4

21-0960D-1

Oral & Dental Conditions Including Mouth, Lips & Tongue (excl. Temporomandibular Joint)

5/7/2013

10/2012

5

21-0960E-1

Diabetes Mellitus

5/2/2013

10/2012

3

21-0960E-2

Endocrine Diseases (Other than Thyroid, Parathyroid or Diabetes Mellitus)

3/15/2012

03/2011

4

21-0960E-3

Thyroid and Parathyroid Conditions

5/7/2013

10/2012

6

21-0960F-1

Scars/Disfigurement

5/2/2013

10/2012

7

21-0960F-2

Skin Diseases

5/2/2013

10/2012

5

21-0960G-1

Esophageal Conditions (Including gastroesophageal reflux disease or GERD, hiatal hernia, etc.)

5/2/2013

10/2012

4

21-0960G-2

Gallbladder and Pancreas Conditions

5/2/2013

10/2012

4

21-0960G-3

Intestinal Conditions (excl. Surgical or Infectious) Incl. Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis, & Diverticulitis

5/2/2013

10/2012

4

21-0960G-4

Intestinal Surgery (Bowel Resection, Colostomy, Ileostomy)

5/2/2013

10/2012

3

21-0960G-5

Hepatitis, Cirrhosis and Other Liver Conditions

5/2/2013

10/2012

5

21-0960G-6

Peritoneal Adhesions

5/2/2013

10/2012

2

21-0960G-7

Stomach and Duodenal Conditions (Not Including Gerd or Esophageal Disorders)

5/2/2013

10/2012

5

21-0960G-8

Infectious Intestinal Disorders, Including Bacterial and Parasitic Infections

5/2/2013

10/2012

3

21-0960H-1

Hernias (Including Abdominal, Inguinal & Femoral Hernias)

5/7/2013

10/2012

3

21-0960H-2

Rectum & Anus Conditions (Including Hemorrhoids)

5/2/2013

10/2012

3

21-0960I-1

Persian Gulf & Afghanistan Infectious Diseases

5/2/2013

10/2012

2

21-0960I-2

HIV - Related Illnesses

5/7/2013

10/2012

5

21-0960I-3

Infectious Diseases (Other than HIV-Related Illness, Chronic Fatigue Syndrome, or Tuberculosis)

5/7/2013

10/2012

3

21-0960I-4

Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases

5/7/2013

10/2012

6

21-0960I-5

Nutritional Deficiencies

5/7/2013

10/2012

2

21-0960I-6

Tuberculosis

5/2/2013

10/2013

4

21-0960J-1

Kidney Conditions (Nephrology)

5/2/2013

10/2012

5

21-0960J-2

Male Reproductive Organ Conditions

5/2/2013

10/2012

6

21-0960J-3

Prostate Cancer

5/2/2013

10/2012

3

21-0960J-4

Urinary Tract (Including Bladder and Urethra) Conditions (Excluding Male Reproductive System)

5/8/2013

10/2012

4

21-0960K-1

Breast Conditions and Disorders

5/2/2013

10/2012

3

21-0960K-2

Gynecological Conditions

5/2/2013

10/2012

6

21-0960L-1

Respiratory Conditions (Other than Tuberculosis and Sleep Apnea)

5/10/2013

10/2012

7

21-0960L-2

Sleep Apnea

5/2/2013

10/2012

2

21-0960M-1

Amputations

5/3/2013

10/2012

4

21-0960M-2

Ankle Conditions

5/3/2013

10/2012

6

21-0960M-3

Non-Degenerative Arthritis (Inflammatory, Autoimmune, Crystalline, Infectious) & Dysbaric Osteonecrosis

5/3/2013

10/2012

5

21-0960M-4

Elbow and Forearm Conditions

5/3/2013

10/2012

5

21-0960M-5

Flatfoot (Pes Planus)

5/3/2013

10/2012

4

21-0960M-6

Foot Misc. (Other Than Flatfoot/PES Planus)

5/3/2013

10/2012

4

21-0960M-7

Hand and Finger Conditions

5/3/2013

10/2012

6

21-0960M-8

Hip and Thigh Conditions

5/3/2013

10/2012

6

21-0960M-9

Knee and Lower Leg Conditions

5/3/2013

10/2012

7

21-0960M-10

Muscle Injuries

5/3/2013

10/2012

6

21-0960M-11

Osteomyelitis

5/3/2013

10/2012

4

21-0960M-12

Shoulder and Arm Conditions

5/3/2013

10/2012

6

21-0960M-13

Neck (Cervical Spine)

5/2/2013

10/2012

6

21-0960M-14

Back (Thoracolumbar Spine) Conditions

5/2/2013

10/2012

6

21-0960M-15

Temporomandibular Joint (TMJ) Conditions

5/3/2013

10/2012

3

21-0960M-16

Wrist Conditions

5/3/2013

10/2012

5

21-0960N-1

Ear Conditions (Including Vestibular and Infectious Conditions)

5/3/2013

10/2012

5

21-0960N-2

Eye Conditions

5/3/2013

10/2012

10

21-0960N-3

Loss of Sense of Smell and/or Taste

5/8/2013

10/2012

2

21-0960N-4

Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx and Pharynx

5/8/2013

10/2012

6

21-0960P-1

Eating Disorders

5/2/2013

10/2012

2

21-0960P-2

Mental Disorders (Other Than PTSD and Eating Disorders)

5/2/2013

10/2012

5

21-0960P-3

Review Post Traumatic Stress Disorder (PTSD)

5/2/2013

10/2012

6

21-0960Q-1

Chronic Fatigue Syndrome

5/8/2013

10/2012

3