What this questionnaire covers
Records eating disorder diagnoses, findings, symptoms and functional effects. Its examiner instructions distinguish initial and review mental-disorder examinations.
Official instructions — page 1Eating Disorders DBQ
Records eating disorder diagnoses, findings, symptoms and functional effects. Its examiner instructions distinguish initial and review mental-disorder examinations.
Current public questionnaire
Download Eating Disorders DBQUpdated 2024-07-31 · v24_1
Use the appropriate condition questionnaire; identify evidence reviewed, complete the applicable findings and examiner certification, and follow the condition-specific instructions below. A form response does not itself establish service connection or a percentage.
Examiner requirements
Initial and review examinations have different named examiner categories. Specified trainees and additional review roles require close supervision; the PDF also requires VHA privileges for the specified nurse practitioner, clinical nurse specialist and physician assistant roles.
Instructions by section
Initial examination: specified examiners
The PDF names the following examiners for initial mental-disorders examinations. It does not authorize any clinician solely because they can access the public form.
- Board-certified or board-eligible psychiatrist.
- Licensed doctorate-level psychologist.
- Non-licensed doctorate-level psychologist working toward licensure under close supervision.
- Psychiatry resident under close supervision.
- VHA psychology trainee under close supervision, completing the specified internship or residency toward a doctorate-level degree.
Review examination: additional roles
Review examinations can also use these specified roles. The supervision and VHA privileging conditions apply as written.
- An examiner eligible to conduct an initial mental-disorders examination.
- Licensed clinical social worker under close supervision.
- Nurse practitioner, clinical nurse specialist or physician assistant, under close supervision and clinically privileged by VHA for the required compensation and pension examination activities.
What close supervision requires
The supervising board-certified/eligible psychiatrist or licensed doctorate-level psychologist must meet with the Veteran, confer on the diagnosis and final assessment, and co-sign the report.
Official instructions — page 1Identify the evidence reviewed
Identify the records reviewed and the date range. Answer the examination-method and clinical-relationship questions from what actually occurred.
Official instructions — page 1Complete the examiner’s certification
The examiner certifies that the information is accurate, complete and current. Complete the signature, date, specialty, contact, National Provider Identifier and medical-license fields requested on the original form.
Official instructions — page 3Review scope
Editorial comparison of this description and revision label with the original questionnaire; not full regulatory mapping or professional review.
Instruction comparison: 2026-10-04. Per-record provider-intent and certification passages compared; full text automatically scanned for examiner-role restrictions. Named mental-health restrictions and selected testing passages separately read. Not a complete clinical instruction or examiner-qualification audit.