What this questionnaire covers
Records cervical motion, functional limitations, neurologic findings, ankylosis and intervertebral disc syndrome (IVDS). Thoracolumbar findings use the Back questionnaire.
Official instructions — page 1Neck (Cervical Spine) DBQ
Records cervical motion, functional limitations, neurologic findings, ankylosis and intervertebral disc syndrome (IVDS). Thoracolumbar findings use the Back questionnaire.
Current public questionnaire
Download Neck (Cervical Spine) DBQUpdated 2024-08-22 · v24_2
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
The PDF is intended for the Veteran’s health care provider. Its general wording does not itself resolve specialty, state scope-of-practice or VA privileging requirements.
Instructions by section
Who completes it
The PDF is intended for the Veteran’s health care provider. Its general wording does not itself resolve specialty, state scope-of-practice or VA privileging requirements.
Official instructions — page 1Cervical scope and functional loss
Selected condition-specific instructions; read the complete current official PDF for definitions, testing and remaining fields.
- This questionnaire concerns the cervical spine; thoracolumbar findings use the Back questionnaire.
- Follow the PDF’s motion, repeated-use and flare-up instructions, including an explanation when testing or an estimate cannot be provided.
Identify 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 14Review 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.