C&P Exam for HIV-related illness (DC 6351)
Which form the examiner uses
For hiv-related illness (DC 6351), the C&P examiner completes the following Disability Benefits Questionnaire (DBQ):
- DBQ RHEUM HIV Related Illnesses (examiner-only DBQ. Link opens VA Find-A-Form search)
DBQs are Department of Veterans Affairs Form 21-0960 series documents. Public DBQs are hosted on benefits.va.gov. A handful are examiner-only and are not posted publicly.
What the examiner records
The fields below are reproduced from the DBQ form the examiner completes for this diagnostic code. This is the structural map of the form, showing what the examiner is asked to measure, observe, and record. It is a factual reproduction of the public DBQ, not advice on how to answer.
This DBQ evaluates HIV-related illnesses including signs and symptoms, secondary diseases, and infectious/oncologic complications.
How DC 6351 maps to this DBQ: for this diagnostic code specifically, the examiner typically completes sections I-III and VII-X of this form. Section III is the condition-specific section for this code. Sections IV-VI cover unrelated conditions on this DBQ and are skipped.
DIAGNOSIS (Section I)
- 1A. Does the Veteran currently have an HIV-related illness? Yes No ICD code: Date of diagnosis: Other (specify): Other diagnosis #1 ICD code: Date of diagnosis: Other diagnosis #2 ICD code: Date of diagnosis: Other diagnosis #3 ICD code: Date of diagnosis: HIV-Related Illnesses
- 1B. If there are additional diagnoses that pertain to an HIV-related illness, list using above format:
MEDICAL HISTORY (Section II)
- 2A. Describe the history (including onset and course) of the Veteran's HIV-related illness(es):
- 2B. Is continuous medication required for control of HIV-related illness(es)? Yes No If "Yes," list only those medications required for the Veteran's HIV-related illness(es)) (If the Veteran has more than one HIV-related illness(es), specify the condition for which each medication is required:
- 2C. Does the Veteran have any complications due to current or previous medications taken for HIV-related illness(es)? Yes No If "Yes," list medication and describe complication(s) due to medication(s): HIV-Related Illnesses
SIGNS, SYMPTOMS AND FINDINGS (Section III)
- 3A. Does the Veteran have any signs, symptoms or findings attributable to an HIV-related illness? Yes No If "Yes," check all that apply: Constitutional symptoms (fever, weight loss, fatigue, malaise, decreased appetite, etc.) attributable to an HIV-related illness If checked, indicate frequency and severity: Refractory Recurrent Describe constitutional symptoms: Diarrhea attributable to an…
SECONDARY DISEASES (Section IV)
- 4A. Does the Veteran have any secondary diseases attributable to an HIV-related illness? Yes No If "Yes," check all that apply: Musculoskeletal system (complete appropriate musculoskeletal questionnaire) Organs of special sense (complete appropriate audio/ENT questionnaire) Respiratory system (complete appropriate respiratory/ENT questionnaire) Cardiovascular system (complete appropriate…
INFECTIOUS AND ONCOLOGIC COMPLICATIONS (Section V)
- 5A. Does the Veteran now have any HIV-related opportunistic infectious or oncologic conditions? Yes No If "Yes," check all that apply: Candidiasis of the bronchi, trachea, esophagus, or lungs Invasive cervical cancer Coccidioidomycosis Cryptococcosis
- 5B. For each checked condition, (except those for which an additional questionnaire is completed), describe (providing date of onset, and brief summary of symptoms, treatment and course): HIV-Related Illnesses
- 5C. Does the Veteran have recurrent opportunistic infection(s)? Yes No If "Yes," describe (providing type of infection(s), date(s) of first onset, brief summary of symptoms, treatment and course): Also complete the appropriate questionnaire(s), if applicable.
SUMMARY (Section VI)
- 6A. Based on symptoms and findings from this exam, complete the following section to provide a summary of the severity of the Veteran's HIV-related condition (this summary provides useful information for VA purposes) check all that apply: Asymptomatic, with or without lymphadenopathy or decreased T4 cell count Symptomatic, development of HIV-related constitutional symptoms Current T4 cell count…
OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS, SYMPTOMS, AND SCARS (Section VII)
- 7A. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the diagnosis section above? Yes No If yes, describe (brief summary): HIV-Related Illnesses
- 7B. Does the Veteran have any scars or other disfigurement (of the skin) related to any conditions or to the treatment of any conditions listed in the diagnosis section? Yes No If yes, also complete the appropriate dermatological questionnaire.
- 7C. Comments, if any:
DIAGNOSTIC TESTING (Section VIII)
- 8A. Has clinically relevant laboratory testing been performed or reviewed in conjunction with this examination? Yes No If "Yes," check all that apply: CD4 (T4 cell) lymphocyte count: Date: Lowest (nadir) CD4 (T4 cell) lymphocyte count, if available: Date if known:
- 8B. Have clinically relevant diagnostic imaging studies or other diagnostic procedures been performed or reviewed in conjunction with this examination and are the results available? Yes No If "Yes," provide type of test or procedure, date and results (brief summary):
- 8C. Are there any other clinically relevant diagnostic test findings or results related to the claimed condition(s) and/or diagnosis(es), that were reviewed in conjunction with this examination? Yes No If "Yes," provide type of test or procedure, date and results (brief summary): HIV-Related Illnesses
FUNCTIONAL IMPACT (Section IX)
- 9A. Do any of the Veteran's HIV-related illnesses or complications impact his or her ability to work? Yes No If "Yes," describe impact of each of the Veteran's HIV-related illness(es), providing one or more examples:
REMARKS (Section X)
- 10A. Remarks (if any – please identify the section to which the remark pertains when appropriate).
Rating Levels for DC 6351
The following tiers are reproduced from 38 CFR Part 4, the VA Schedule for Rating Disabilities. Toggle between the official VA criteria and a Plain English explanation.
Plain-English summaries are AI-generated to explain the official criteria. The official 38 CFR language is the binding legal standard. When in doubt, ask a VSO.
Disclaimer: This page reproduces public Department of Veterans Affairs forms (DBQs) and verbatim text from 38 CFR Part 4 (the VA Schedule for Rating Disabilities). It is informational only and is not legal or medical advice. For guidance on a specific claim, contact a VA-accredited representative.