C&P Exam for Amyotrophic lateral sclerosis (DC 8017)

Read the C&P exam preparation guideWhat happens at the exam, what 38 CFR Part 4 requires the examiner to record, and what to bring.
Diagnostic code: 8017Condition: Amyotrophic lateral sclerosisRegulation: 38 CFR § 4.124aDBQ: DBQ NEURO ALS Lou Gehrigs Disease

Which form the examiner uses

For amyotrophic lateral sclerosis (DC 8017), the C&P examiner completes the following Disability Benefits Questionnaire (DBQ):

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 amyotrophic lateral sclerosis (ALS) including conditions/symptoms, neurologic exam, mental health manifestations, housebound and aid & attendance status, and assistive devices.

How DC 8017 maps to this DBQ: for this diagnostic code specifically, the examiner typically completes sections I-III, V, X, and XIII-XV of this form. Section III is the condition-specific section for this code. Sections IV, VI-IX, and XI-XII cover unrelated conditions on this DBQ and are skipped.

8 of 15 sections apply to DC 8017 on this DBQ
DIAGNOSIS (Section I) MEDICAL HISTORY (Section II) CONDITIONS, SIGNS AND SYMPTOMS DUE TO ALS (Section III) OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS AND/OR SYMPTOMS (Section V) ASSISTIVE DEVICES (Section X) DIAGNOSTIC TESTING (Section XIII) FUNCTIONAL IMPACT (Section XIV) REMARKS (Section XV)
DIAGNOSIS (Section I)
  • 1A. Does the Veteran now have or has he or she ever been diagnosed with amyotrophic lateral sclerosis (ALS)? Yes No
  • 1B. If "Yes," provide only diagnoses that pertain to ALS: Diagnosis # 1 - ICD code - Date of diagnosis - Diagnosis # 2 - ICD code - Date of diagnosis - Diagnosis # 3 - ICD code - Date of diagnosis - Amyotrophic Lateral Sclerosis
  • 1C. If there are additional diagnoses that pertain to amyotrophic lateral sclerosis, list using above format:
MEDICAL HISTORY (Section II)
  • 2A. Describe the history (including onset and course) of the Veteran's ALS (brief summary):
  • 2B. Dominant hand Right Left Ambidextrous
CONDITIONS, SIGNS AND SYMPTOMS DUE TO ALS (Section III)
  • 3A. Does the Veteran report any muscle weakness in the upper and/or lower extremities attributable to ALS? Yes No (If "Yes," document under strength testing in neurologic exam section)
  • 3B. Does the Veteran have any pharynx and/or larynx and/or swallowing conditions attributable to ALS? Yes No (If "Yes," check all that apply) Constant inability to communicate by speech Speech not intelligible or individual is aphonic Paralysis of soft palate with swallowing difficulty (nasal regurgitation) and speech impairment Hoarseness Dysphagia (difficulty swallowing)
  • 3C. Does the Veteran report any respiratory conditions attributable to ALS? Yes No (If "Yes," provide PFT results under "Diagnostic Testing" Section)
  • 3D. Does the Veteran report signs and/or symptoms of sleep apnea or sleep apnea-like condition attributable to ALS? Note: If signs and/or symptoms of sleep apnea or sleep apnea-like condition are due to ALS, these symptoms are due to weakness in the palatal, pharyngeal, laryngeal, and/or respiratory musculature. A sleep study is not indicated to report symptoms of sleep apnea or sleep apnea-like…
  • 3E. Does the Veteran have impairment of sphincter control attributable to ALS? Yes No If "Yes," indicate severity: History of loss of sphincter control, currently asymptomatic Complete loss of sphincter control Partial loss of sphincter control
  • 3F. Does the Veteran report bowel incontinence to solids and/or liquids attributable to ALS? Yes No If "Yes," indicate frequency: Less than once every six months, which requires wearing a pad at least once every six months At least once every six months, which requires wearing a pad at least once every six months Two or more times per month, which requires wearing a pad two or more times per…
  • 3G. Does the Veteran have a physician-prescribed bowel program? Yes No If "Yes," indicate responsiveness: Fully responsive Partially responsive Not responsive Indicate the bowel program requirements (Check all that apply) Special diet
  • 3H. Does the Veteran report gastrointestinal symptoms attributable to ALS? Yes No If "Yes," check all that apply Change in stool frequency Change in stool form Altered stool passage (straining and/or urgency) Mucorrhea Abdominal bloating Subjective distention Constipation Other (specify): Abdominal pain related to defecation (if checked, indicate frequency during the previous 3 months) None At…
  • 3I. Does the Veteran report voiding dysfunction causing urine leakage attributable to ALS? Yes No (If "Yes," check all that apply) Does not require/does not use absorbent material Requires absorbent material that is changed less than 2 times per day Requires absorbent material that is changed 2 to 4 times per day Requires absorbent material that is changed more than 4 times per day
  • 3J. Does the Veteran report voiding dysfunction causing signs and/or symptoms of urinary frequency attributable to ALS? Yes No (If "Yes," check all that apply) Daytime voiding interval greater than 3 hours Nighttime awakening to void less than 2 times Daytime voiding interval between 2 and 3 hours Nighttime awakening to void 2 times Daytime voiding interval between 1 and 2 hours Nighttime…
  • 3K. Does the Veteran have voiding dysfunction causing findings, or report signs and/or symptoms of obstructed voiding attributable to ALS? Yes No (If "Yes," check all signs and symptoms that apply) Hesitancy (If checked, is hesitancy marked?) Yes No Amyotrophic Lateral Sclerosis
  • 3L. Does the Veteran have voiding dysfunction requiring the use of an appliance attributable to ALS? Yes No (If "Yes," describe appliance):
  • 3M. Does the Veteran have a history of recurrent symptomatic urinary tract infections attributable to ALS? Yes No (If "Yes," check all treatments that apply) No treatment Suppressive drug therapy Lasting 6 months or longer For less than 6 months Hospitalization
  • 3N. Does the Veteran report erectile dysfunction or female sexual arousal disorder (FSAD) attributable to ALS? Note: Female Sexual Arousal Disorder (FSAD) refers to the continual or recurrent physical inability of a woman to accomplish or maintain an ample lubrication- swelling reaction during sexual intercourse. Decreased blood flow to the genital area is believed to contribute to FSAD similar…
NEUROLOGIC EXAM (Section IV)
  • 4A. Speech Normal Abnormal (If speech is abnormal, describe):
  • 4B. Gait Normal Abnormal (describe): (If gait is abnormal and the veteran has more than one medical condition contributing to the abnormal gait, identify the condition(s) and describe each condition's contribution to the abnormal gait):
  • 4C. Strength - Rate strength according to the following scale: 0/5 No muscle movement 2/5 No movement against gravity 4/5 Less than normal strength 1/5 Visible muscle movement, but no joint movement 3/5 No movement against resistance 5/5 Normal strength All Normal Shoulder flexion: Right: 5/5 4/5 3/5 2/5 1/5 0/5 Left: 5/5 4/5 3/5 2/5 1/5 0/5 Shoulder abduction: Right: 5/5 4/5 3/5 2/5 1/5 0/5…
  • 4D. Deep tendon reflexes (DTRs) - Rate reflexes according to the following scale: 0 Absent 1+ Decreased 2+ Normal 3+ Increased without clonus 4+ Increased with clonus All Normal Biceps: Right: 0 1+ 2+ 3+ 4+ Left: 0 1+ 2+ 3+ 4+ Triceps: Right: 0 1+ 2+ 3+ 4+ Left: 0 1+ 2+ 3+ 4+
  • 4E. Does the Veteran have muscle atrophy attributable to ALS? Yes No (If muscle atrophy is present, indicate location): (When possible, provide difference measured in cm between normal and atrophied side, measured at maximum muscle bulk: cm.)
  • 4F. Summary of muscle weakness in the upper and/or lower extremities attributable to ALS (check all that apply): Right upper extremity muscle weakness: None Mild Moderate Severe Complete (no remaining function) With atrophy Left upper extremity muscle weakness: None Mild Moderate Severe Complete (no remaining function) With atrophy Right lower extremity muscle weakness: None Mild Moderate Severe…
OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS AND/OR SYMPTOMS (Section V)
  • 5A. Does the Veteran have any other pertinent physical findings, complications, conditions, signs and/or symptoms related to any conditions listed in the diagnosis section? Yes No (If "Yes," describe (brief summary)):
  • 5B. Does the Veteran have any scars (surgical or otherwise) 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.
  • 5C. Comments, if any:
MENTAL HEALTH MANIFESTATIONS DUE TO ALS OR ITS TREATMENT (Section VI)
  • 6A. Does the Veteran have depression, cognitive impairment or dementia, or any other mental disorder attributable to ALS and/or its treatment? Yes No (If "Yes," ALSO complete the Mental Disorders Disability Benefits Questionnaire (schedule with appropriate provider))
HOUSEBOUND (Section VII)
  • 7A. Due to ALS, is the Veteran substantially confined to his or her dwelling and the immediate premises (or if institutionalized, to the ward or clinical areas)? Yes No (If "Yes," describe how often per day or week and under what circumstances the Veteran is able to leave the home or immediate premises): Amyotrophic Lateral Sclerosis
AID AND ATTENDANCE (Section VIII)
  • 8A. Is the Veteran able to dress or undress him or herself without assistance? Yes No
  • 8B. Does the Veteran have sufficient upper extremity coordination and strength to be able to feed him or herself without assistance? Yes No
  • 8C. Is the Veteran able to attend to the wants of nature (toileting) without assistance? Yes No
  • 8D. Is the Veteran able to bathe him or herself without assistance? Yes No
  • 8E. Is the Veteran able to keep him or herself ordinarily clean and presentable without assistance? Yes No
  • 8F. Does the Veteran need frequent assistance for adjustment of any special prosthetic or orthopedic appliance(s) Yes No (If "Yes," describe): Note: For VA purposes, "bedridden" will be that condition which actually requires that the claimant remain in bed. The fact that claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day…
  • 8G. Is the Veteran bedridden? Yes No
  • 8H. Does the Veteran require care and/or assistance on a regular basis due to his or her physical and/or mental disabilities in order to protect him or herself from the hazards and/or dangers incident to his or her daily environment? Yes No
  • 8I. List any condition(s), in addition to the Veteran's ALS, that causes any of the above limitations:
NEED FOR HIGHER LEVEL AID & ATTENDANCE (A&A) (Section IX)
  • 9A. Does the Veteran require a higher, more skilled level of A&A? Yes No Note: For VA purposes, this skilled, higher level care includes (but is not limited to) health-care services such as physical therapy, administration of injections, placement of indwelling catheters, changing of sterile dressings, and/or like functions which require professional health-care training or the regular…
ASSISTIVE DEVICES (Section X)
  • 10A. Does the Veteran use any assistive device(s) as a normal mode of locomotion, although occasional locomotion by other methods may be possible? Yes No (If "Yes," identify assistive device(s) used (check all that apply and indicate frequency)): Wheelchair Frequency of use: occasional regular constant Brace(s) Frequency of use: occasional regular constant Crutch(es) Frequency of use: occasional…
  • 10B. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition:
REMAINING EFFECTIVE FUNCTION OF THE EXTREMITIES (Section XI)
  • 11A. Due to the ALS condition, is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc., while functions for the lower extremity include balance and propulsion, etc.) Yes, functioning is so diminished that…
  • 11B. If "Yes," indicate extremity(ies) (Check all extremities for which this applies) Right upper Left upper Right lower Left lower (For each checked extremity, describe loss of effective function, identify the condition causing loss of function, and provide specific examples) (brief summary): Amyotrophic Lateral Sclerosis
FINANCIAL RESPONSIBILITY (Section XII)
  • 12A. In your judgment, is the Veteran able to manage his or her benefit payments in his or her own best interest, or able to direct someone else to do so? Yes No (If "No," provide rationale):
DIAGNOSTIC TESTING (Section XIII)
  • 13A. Have PFTs been performed? Yes No (If "Yes," provide most recent results, if available): FEV-1: % predicted Date of test: FVC: % predicted Date of test: FEV-1/FVC: % Date of test:
  • 13B. If PFTs have been performed, is the flow-volume loop compatible with upper airway obstruction? Yes No
  • 13C. Are there any other significant diagnostic test findings and/or results? Yes No (If "Yes," provide type of test or procedure, date and results (brief summary)):
FUNCTIONAL IMPACT (Section XIV)
  • 14A. Does the Veteran's ALS impact his or her ability to work? Yes No (If "Yes," describe the impact of the Veteran's ALS, providing one or more examples) Amyotrophic Lateral Sclerosis
REMARKS (Section XV)
  • 15A. Remarks (if any - please identify the section to which the remark pertains when appropriate).

Rating Levels for DC 8017

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.

View the full DC 8017 pageSearch BVA decisions for this codeAbout DBQ forms

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.