2900-0781 (Group 4), Comments/Responses

Disability Benefits Questionnaire (Group 4),

Comments/Responses Supplemental Document

A comment was received previously during the extension submitted in FY2015. The comments/responses per form listed in the information collection in this grouping have resulted in both substantive and non-substantive changes.

Comment Received:

A comment received from Genevieve Gutierrez, QTC-A Lockheed Martin Company proposed changes to each of the DBQs that make up Group IV.  The proposed changes consist of both substantive and non-substantive changes. The extent of this comment has been added to this information collection as a supplementary document.

VBA Response:

Note: During the analysis of the comments received, it was noted that the commenter was referring to a previous version of the form, not the versions submitted to the information collection request. As such, their comments were unnecessary as the change had already been made to the form. The language ‘previous version’ will be noted in the response to delineate that this comment refers to this instance.

The following has been added to all the forms listed in this grouping:

Question:

1A - Rationale is not asked for when there is no diagnosis

Answer:

The following note has been added to the following forms between Questions 1A & 1B; C-3, C-6, C-7, C-11, D-1, E-2, E-3, H-1, I-2, I-3, I-4, I-5, J-4, L-1, N-3, N-4, & Q-1.

NOTE: These are the diagnoses determined during this current evaluation of the claimed condition(s) listed above. If there is no diagnosis, if the diagnosis is different from a previous diagnosis for this condition, or if there is a diagnosis of a complication due to the claimed condition, explain your findings and reasons in comments section. Date of diagnosis can be the date of the evaluation if the clinician is making the initial diagnosis, or an approximate date determined through record review or reported history.

Question:

Scar criteria are missing from the following forms:

Answer:

Additional information was added to stay consistent with other DBQ forms already updated. The additional information was added to; C-3 (Q8A), C-11 (Q6A), D-1 (Part G, Q1), E-2 (Q10A), H-1 (Q5A), I-2 (Q9A), I-3 (Q5A), I-5 (Q4A), J-4 (Q9A), L-1 (Part L, Q1), N-3 (Q5A), N-4 (Part F, F1), & Q-1 (Q5A).

Question:

A continuous medication question needs to be added to Section III-Medical History.

Answer:

Agree. The following forms; D-1, H-1, I-3, J-4, N-3, and N-4, have been modified to include this additional question, as follows:

IS CONTINUOUS MEDICATION REQUIRED FOR CONTROL OF THE VETERAN’S XXXXXXX CONDITION?

YES / NO (If “Yes,” list only those medications required for the veteran’s xxxxx condition.)

(Leave space for a fillable)

The following are additional changes by form:

VAF 21-0960C-3:

Question:

Note added in Section I to include DBQ exam for those conditions in lieu of this worksheet.

Answer:

Disagree. A review of the section did not contain this note.

Question:

Section 2 for Medical Record Review was added. Is it now required to ask for MR?

Answer:

Agree. Question 2 of Section II is for Medical Record Review. VAF 21-0960I-5 is the only DBQ form not updated with this section in the group. This form is being modified to include this material.

Questions:

3B - second option added cranial nerve VI.

3B - Cranial nerve VIII was added.

4 - Section 4 used to refer to cranial nerves V-XII. It has been changed to cranial nerves V, VII, and/or IX-XII.

Answer:

Each of these questions refers to a previous version, thus no change.

Question:

4K - Gastrointestinal symptoms description or symptoms has been removed.

Answer:

Disagree. A review of this question shows: 4K. GASTROINTESTINAL SYMPTOMS (If checked, indicate severity):

Question:

4M - Section 4 now asks to indicate cranial nerve involved for all checked findings.

Removed 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?"

Answer:

Disagree. A review of this form reveals that there is no question 4M and salivation (increased and decreased) are covered under question 4I&J.

VAF 21-0960C-6:

Question:

Added Section 4A a new check box "sleep onset/ sleep offset hallucinations" instead of just 'hallucinations."

Answer:

A review shows Question 4A as follows: 4A. DOES THE VETERAN HAVE A CONFIRMED DIAGNOSIS OF NARCOLEPSY? Sleep onset/sleep offset hallucinations is listed under 4B. No change.

VAF 21-0960C-7:

Question:

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?

Answer:

Agree. We have removed the following: “If checked, describe line next to muscle weakness.”

Questions:

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?"

Answer:

Each of these questions refers to a previous version, thus no change.

VAF 21-0960C-11:

Question:

5D - separated 0 and 1.

Answer:

This question refers to a previous version, thus no change.

Question:

5C 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?

Answer:

Agreed. A review of the questions shows 5C as follows: Number of minor seizures over past 6 months” with multiple options following that. Question 5E is worded as follows: Number of minor psychomotor seizures over past 6 months: Question 5C has been changed to match 5E.

VAF 21-0960D-1:

Question:

Section 3B excluded question regarding continuous medication.

Answer:

Agree. The question regarding continuous medication has been added back into this question. Other forms in this group have been updated with this change to be consistent.

Questions:

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 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?"

Answer:

Each of these questions refers to a previous version, thus no change.

Question:

Section 4 Part D 2 reworded sentence "Does the Veteran have a mouth injury that results in impairment of mastication?"

Answer:

Disagree. A review shows the question worded as follows: 2. DOES THE VETERAN HAVE A MOUTH INJURY THAT RESULTS IN IMPAIRMENT OF MASTICATION?

Question:

Section V excluded MRI and CT testing.

Answer:

True, but no change is necessary. The VA Schedule for Rating Disabilities (VASRD) does not need this information. It is not standard to do either of these. The next question on form offers remarks to have the doctor specify which test was conducted.

VAF 21-0960E-2:

Question:

Section 1B now includes "Hypopituitarism, Hypogonadism and Osteoporosis."

Answer:

Disagree. They are all endocrine-related.

Question:

Section 9 has 2 9C questions. Renumber and then change instructions to say "If "yes," complete Items 9B, 9C, 9D, 9E & 9F."

Answer:

The instructions have been changed to state: “(If "Yes," complete Items 9D, 9E and 9F).

VAF 21-0960E-3:

Question:

4A - Options are 0, 1-3 and more than 4. What do you select if you have had 4 episodes?

Answer:

Agree. 4A has been changed from 1-3 to 1-4.

Question:

4C and 4D - Fatigability requires an extra box for a description, and 4D says to describe all checked conditions. The description for fatigability will be redundant.

Answer:

Agree. The description box for fatigability has been removed.

Question:

4E and 4F - Weakness requires an extra box for a description, and 4F says to describe all checked conditions. The description for weakness will be redundant.

Answer:

Agree. The box for weakness has been removed.

Question:

5B - 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."

Answer:

A review shows the note following question 5B is correct as follows: (If checked, describe by completing Section VII, Scars or other Disfigurement of the Neck).

Question:

5D - Do we want just one BP or do we want 3 BP readings?

Answer:

Disagree. There is no requirement in the VASRD for endocrine conditions that 3 BP readings are required.

Question:

8D - 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?

Answer:

Agree. “IN ITEM 8C?” has been removed from the question in 8D and a question mark has been added to the end of the sentence.

VAF 21-0960H-1:

Question:

Section 4, 1D, 2D, and 3C added a box "N/A no truss or belt tried or used."

Answer:

This question is based on a previous version, thus no change.

VAF 21-0960I-2:

Question:

Section 5A dropped the question regarding HIV associated neuro-cognitive disorder.

Answer:

A review shows that this information is under Section VII.

VAF 21-0960I-4:

Question:

Question 5 is asked twice, once before 5A and once before 5E.

Answer:

Agree. Question 5 has been modified as follows:

(If "Yes," complete the following Items 5A thru 5K). The additional checkboxes and question has been removed.

The title of this form had a typo and has been fixed; Erythematosus.

VAF 21-0960I-5:

Question:

Section II added to indicate medical record review.

Answer:

To stay consistent with the other forms in group, the addition of Section II-Medical Record Review has been added.

Question:

Section III, item 3A created separate check boxes for some of the findings, signs, or symptoms.

Answer:

Each of these questions refers to a previous version, thus no change.

VAF 21-0960J-4:

Question:

Section VII, item 7E added a question "Has the Veteran had other bladder surgery?"

Answer:

This question is based on a previous version, thus no change.

VAF 21-0960L-1:

Question:

1A - added a diagnosis option of "Constrictive Diarrhea.”

Answer:

Disagree – A review shows question 1A as follows: 1A. DOES THE VETERAN NOW HAVE OR HAS HE OR SHE EVER BEEN DIAGNOSED WITH A RESPIRATORY CONDITION? (This is the condition the veteran is claiming or for which an exam has been requested.)

Question 1B has CONSTRICTIVE BRONCHIOLITIS which needs to stay in the DBQ but there is no Constrictive Diarrhea.

Question:

Section IV Part A, question regarding Asthma reworded but contains essentially the same information.

Answer:

This question is based on a previous version, thus no change.

During our analysis, we have also made the additional change; Under Section V-Diagnostic Testing, the ‘DLCO’ value for Post-bronchodilator (5C) has been removed. This is no DLCO for post-bronchodilator.

VAF 21-0960N-4:

Questions:

1B - "Vasomotor Rhinitis" changed terminology to "Non-allergic Rhinitis?"

Section 4 - added a section to select the condition that is present and then the provider will complete that section?

Section 4 - question B5 has the option "Lethal midline" and it should say "Lethal midline granuloma?"

Section 4 - question C8 added "Does the veteran have vocal cord paralysis or any other pharyngeal or laryngeal condition?"

5B - bronchoscopy option added?

Answer:

These questions are based on a previous version, thus no changes are needed.

Question:

5D - for the question "Is the Flow-Volume Loop compatible with upper airway obstruction?" there is an option for YES, but no option for NO.

Answer:

A review of DBQ Form 21-0960N-4 does indeed have an option for YES and NO as follows:

(Is the Flow-Volume Loop compatible with upper airway obstruction?)

Yes No

VAF 21-0960Q-1:

Question:

3C - If the answer is NO, the question asks for a description. What is the physician supposed to describe?

Answer:

The physician is supposed to describe why they didn’t rule out/consider/exclude other clinical conditions that may produce similar symptoms etc.

Question:

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.

Answer:

Disagree. No change as question 4E asks the clinician as follows: 4E. SPECIFY FREQUENCY OF SYMPTOMS: