Esophageal Conditions

Your doctor will complete VA Form 21-0960G-1 (Esophageal Conditions DBQ) after examining you. This walkthrough helps you prepare them. The DBQ is a standardized questionnaire; your doctor's answers directly determine your VA rating. Brief them on these specific points before the exam so nothing important is missed or underdocumented.

Common mistakes

• ×Asking your doctor to just "fill out the VA form" without briefing them - an uninformed completion is often generic and leads to lower ratings.
• ×Bringing the DBQ to a provider who has never seen you before - your treating physician who knows your history will write the most credible documentation.
• ×Going to the exam and waiting for the doctor to ask questions - come prepared with specific examples of your worst days and functional limitations.

These are the key clinical questions from the Esophageal Conditions DBQ. Help your doctor understand what each question is asking and give them concrete examples for your situation. Print this section and bring it to the appointment. 1. Do you experience dysphagia (difficulty swallowing)? WHY IT MATTERS: Dysphagia severity directly affects rating level for esophageal conditions TIPS: Describe whether difficulty is with solids, liquids, or both; Note if you need to modify your diet due to swallowing problems 2. How frequently do you experience regurgitation and substernal pain? WHY IT MATTERS: Persistent regurgitation with substernal/arm/shoulder pain supports a 30% rating for hiatal hernia TIPS: Track frequency and severity of episodes; Note if symptoms occur despite medication 3. Have you experienced weight loss due to your esophageal condition? WHY IT MATTERS: Material weight loss combined with other symptoms supports higher rating levels TIPS: Document weight changes over time; Note any dietary restrictions required 4. What treatments have been tried and how effective are they? WHY IT MATTERS: Refractory symptoms despite treatment supports higher ratings TIPS: List all medications and dosages; Note if symptoms persist despite maximum medical therapy 5. Have you had any esophageal procedures or surgeries? WHY IT MATTERS: Surgical history and complications affect overall rating consideration TIPS: Bring operative reports and post-surgical records; Document any complications from procedures

Common mistakes

• ×Not documenting weight loss with actual numbers and dates
• ×Failing to mention symptoms that persist despite medication
• ×Not describing the full impact on diet and nutrition

VA raters use the Esophageal Conditions DBQ to determine your disability rating. The most important rating factors for this condition are: 1. Severity of dysphagia (liquid vs solid food restriction) 2. Presence of substernal, arm, or shoulder pain 3. Frequency and severity of regurgitation 4. Whether there is material weight loss or hematemesis/melena with anemia 5. Whether esophageal stricture permits only liquids 6. Impact on overall health and nutrition For each factor, give your doctor specific examples from your daily life so they can document accurately (not generically).

Common mistakes

• ×Overlooking secondary conditions like anemia or aspiration

Authority

• 38 CFR 4.1 - Functional impairment as the basis for rating.

Preparation checklist for the Esophageal Conditions DBQ exam: 1. Bring endoscopy and barium swallow results 2. Track weight changes and dietary restrictions 3. Document frequency and severity of regurgitation episodes 4. List all medications tried including dosages and effectiveness 5. Describe how symptoms affect eating, sleeping, and daily life Remember: Describe your WORST days, not your average days. VA raters evaluate the full range of your disability including its worst manifestations.

Common mistakes

• ×Describing your best days or average functioning instead of your worst - VA rates the full range of disability.
• ×Minimizing symptoms out of stoicism or pride - accurate documentation is not exaggeration; it is honesty.
• ×Not mentioning secondary symptoms, side effects, or additional conditions the doctor may not ask about.