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["DISABILITY BENEFITS QUESTIONNAIRE GROUP IV REVIEW "]
["Proposed 8/28/2014 Comments due by 10/27/2014"]
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["Form Number",null,"NAME",null,"COMMENTS"]
["21-0960C-3",null,"Cranial Nerve Conditions DBQ",null,"Note added in Section I to include DBQ exam for those conditions in lieu of this worksheet.                            Added section 2 for Medical Record Review.  Is it now required to ask for MR? \n3B - second option added cranial nerve VI\n3B - Cranial nerve VIII was added\n4 - Section 4 used to refer to cranial nerves V-XII. It has been changed to cranial nerves V, VII, and/or IX-XII.\n4K - Gastrointestinal symptoms description or symptoms has been removed\n4M - Section 4 now asks to indicate cranial nerve involved for all checked findings.\nRemoved this question \"Does the Veteran have any other significant signs or symptoms of a cranial nerve condition, such as impaired salivation or lacrimation due to cranial nerve VII condition?\"\n"]
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["21-0960C-6",null,"Narcolepsy DBQ",null,"Added Section II regarding medical record review, Is it now required to ask for MR?                          Added Section 4A a new check box \"sleep onset/ sleep offset hallucinations\" instead of just 'hallucinations\""]
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["21-0960C-10",null,"Peripheral Nerve Conditions (Not including Diabetic Sensory-Motor Peripheral Neuropathy) DBQ",null,"Reviewed under Group I. Information was received that VA Form 21-0960C-10, Peripheral Nerves Conditions (Not Including Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire,  was published in the Federal Register on July 17, 2014 correcting expiration date and revision date to June 2014.  However, DBQ listed in the Federal Register is dated December  2010 which has significant changes.  Which is correct?"]
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["21-0960C-7",null,"Fibromyalgia DBQ",null,"Added Section II regarding medical record review, Is it now required to ask for MR?                                 4A - Took out the describe boxes next to each symptom and instead put one describe box at the end for all checked conditions. Why then, is there an extra box to describe muscle weakness by itself?                                                                                      Added a note in Section IV regarding the need to complete a \"Mental Disorder DBQ\" for any Mental Health condition noted as due to Fibromyalgia, Section 4C added new check boxes for \"None\" and \"all Bilaterally\""]
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["21-0960C-11",null,"Seizure Disorders (Epilepsy) DBQ",null,"Added Section II regarding medical record review,Is it now required to ask for MR?                                    5D - separated 0 and 1\n5C and 5E - first option for average frequency states \"none in past 6 months\" in 5C and \"less than 1 in past 6 months\" in 5E.  Should they be consistent with each other?"]
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["21-0960D-1",null,"Oral and Dental Conditions Including Mouth, Lips and Tongue (Other than Temporomandibular Joint Conditions) DBQ",null,"Added Section II regarding medical record review,  Is it now required to ask for MR?                        Section 3B excluded question regarding continuous medication, Section 4 added check boxes \"Does the Veteran have any of the following Dental or Oral Conditions.\"               Section 4C added check boxes regarding teeth loss for \"no missing teeth upper and lower, and all posterior teeth missing bilaterally, both upper and lower\",                                                                           Section 4 Part D 2 reworded sentence \"Does the Veteran have a mouth injury that results in impairment of mastication?, \"                                  Section 4 Part E  added a new question \"Does the Veteran now have or has he or she ever been diagnosed with Bisphosphonate-Related Osteonecrosis of the jaw?\",                                  Section V excluded MRI and CT testing."]
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["21-0960E-2",null,"Endocrine Diseases (other than Thyroid, Parathyroid or Diabetes Mellitus) DBQ",null,"Section 1B now includes \"Hypopituitarism, Hypogonadism and Osteoporosis\",                    Section II added to indicate medical record review. These notes are based on a review of  the DBQ in the QTC website. DBQ on VA website is unchanged from the proposed DBQ 21-0960E-2  Section 9 has 2 9C questions. Renumber and then change instructions to say \"If \"yes,\" complete Items 9B, 9C, 9D, 9E & 9F\""]
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["21-0960E-3",null,"Thyroid and Parathyroid Conditions DBQ",null,"Added section 2 for Medical Record Review.  Is it now required to ask for MR? Can we bill for MR?\n4A - Options are 0, 1-3 and more than 4.  What do you select if you have had 4 episodes?\n4C and 4D - Fatiguability requires and extra box for a description, and 4D says to describe all checked conditions. The description for fatiguability will be redundant.\n4E and 4F - Weakness requires and extra box for a description, and 4F says to describe all checked conditions. The description for weakness will be redundant.\n5B - If disfigurement is found, instructions are to describe in section 6, Reflex exam. It should say \"Section 7, Scars or Other Disfigurement of the Neck\"\n5D - Do we want just one BP or do we want 3 BP readings?\n8D - Asks for residuals other than those already documented in Item 8C. 8C is regarding treatment, not residuals. Is there another section that we should reference?"]
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["21-0960H-1",null,"Hernias (Including Abdominal, Inguinal, and Femoral Hernias) DBQ",null,"These notes are based on a review of  the DBQ in the QTC website.                                                       Section II added to indicate medical record review.                                                                          Section 3 regarding medical history dropped question regarding continuous medication.                                           Section 4, 1D,2D, and 3C added a box \"N/A no truss or belt tried or used\"."]
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["21-0960I-2",null,"HIV-Related Illnesses DBQ",null,"These notes are based on a review of  the DBQ in the QTC website. Section II added to indicate medical record review. Section 5A dropped the question regarding HIV associated neuro-cognitive disorder."]
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["21-0960I-3",null,"Infectious Diseases (other than HIV-Related Illness, Chronic Fatigue Syndrome, and Tuberculosis DBQ",null,"These notes are based on a review of  the DBQ in the QTC website. Section II added to indicate medical record review. Section 3 regarding medical history dropped question regarding continuous medication."]
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["21-0960I-4",null,"Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases DBQ",null,"These notes are based on a review of  the DBQ in the QTC website. Section II added to indicate medical record review. Question 5 is asked twice. Once before 5A and once before 5E."]
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["21-0960I-5",null,"Nutritional Deficiencies DBQ",null,"These notes are based on a review of  the DBQ in the QTC website. Section III , item 3A created separate check boxes for some of the findings, signs, or symptoms.This DBQ does not have an added Medical Record Review like the other DBQs"]
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["21-0960J-4",null,"Urinary Tract (including Bladder & Urethra) Conditions DBQ",null,"These notes are based on a review of  the DBQ in the QTC website, Added section 2 for Medical Record Review.  Is it now required to ask for MR?Section VII, item 7E added a question \"Has the Veteran had other bladder surgery?\""]
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["21-0960L-1",null,"Respiratory Conditions (other than Tuberculosis and Sleep Apnea) DBQ",null,"These notes are based on a review of  the DBQ in the QTC website. 1A - added a diagnosis option of \"Contrictive Diarrhea\"Section II added to indicate medical record review. Section IV Part A Question regarding Asthma reworded but contains essentially the same information."]
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["21-0960N-3",null,"Loss of Sense of Smell and/or Taste DBQ",null,"These notes are based on a review of  the DBQ in the QTC website. Section II added to indicate medical record review. "]
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["21-0960N-4",null,"Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx, and Pharynx DBQ",null,"1B - \"Vasomotor Rhinitis\" changed terminology to \"Non-allergic Rhinitis\"\nAdded section 2 for Medical Record Review.  Is it now required to ask for MR? Can we bill for MR?\nSection 3 - dropped question for continuous medication\nSection 4 - added a section to select the condition that is present and then the provider will complete that section\nSection 4 - question B5 has the option \"Lethal midline\" and it should say \"Lethal midline granuloma\"\nSection 4 - question C8 added \"Does the veteran have vocal cord paralysis or any other pharyngeal or laryngeal condition?\"\n5B - bronchoscopy option added\n5D - for the question \"Is the Flow-Volume Loop compatible with upper airway obstruction?\" there is an option for YES, but no option for NO.\n"]
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["21-0960Q-1",null,"Chronic Fatigue Syndrome DBQ",null,"These notes are based on a review of  the DBQ in the QTC website. Section II added to indicate medical record review. 3C - If the answer is NO, the question asks for a description. What is the physician supposed to describe?Section IV, items 4B, 4D, and 4F added to ask examiner to provide a description of the conditions.  Prior VBA DBQ Section IV, item 4f asked examiner to provide a description of the frequency of the condition."]