DBQ Individual Unemployability Statement Form that is not a DBQ

[pacmanx1]

Over the past few years, I have been trying to figure out and find a blank DBQ Individual Unemployability Statement Form. It seems that this form may have originated from the LHI corporation, but I have finally found an example on-line. This form is used by a medical examiner to fill out.  I feel that the VA should still make them available to the public. It seems that this form can be tailored for any disability symptoms because this particular form is for a Mental Health (Medical opinion) Individual Unemployability Statement and the one I found in my records was for a different disability.  I think if the VA would make this form available to the public, it would make it a lot easier for some veterans to be granted TDIU.

MO-re-TDIU-Form-re-Psych.pdf (seankendalllaw.net)

[brokensoldier244th]

It isn't its own DBQ. Its an optional field that can be applied to any exam type or contention that the veteran has claimed on an 21-8940. 

 

[pacmanx1]

In my case the LHI examiner filled out the regular DBQ (disability symptoms) and then filled out this separate medical opinion. That is why I titled the post of this separate form. It surprised me because even though the examiner and I discussed my symptoms and my ability to work and the fact that I have not worked in quite some time, I did know that this form along with my regular DBQ examination was in my records. As stated, I have been searching for an example of this form for several years and search would always come back as VA Form 21-8940. 

 

[brokensoldier244th]

8940 is the application for IU, and in its current form a doctor fills out a portion of it. That form is then submitted with whatever other evidence is sent and if an exam is needed an employment impact statement is asked of the examiner. There isn't a DBQ to be made available to the public because it isn't a separate DBQ, it is an addition to whatever DBQ(s) the examiner is completing- at least in its current iteration within the last 5 yrs, and probably longer because my IU determination (at the time 2014) was also an addendum to my existing DBQ. 

[pacmanx1]

23 hours ago, brokensoldier244th said:

8940 is the application for IU, and in its current form a doctor fills out a portion of it.

Not sure what I am missing but since there is no section for a Doctor/Physician to fill out on a VA form 21-8940, I can only presume you are referring to a DBQ Form. The only forms that need to be submitted with the VA Form 21-8940 are VA form 21-4192 Employment Information and the VA Form 21-4142 Doctor Medical Release Information. Yes, a medical examiner fills out the DBQ forms and they can if requested or if they choose to fill out a separate and additional Individual Unemployability Statement. IMHO, since the VA accepts this Individual Unemployability Statement from one medical corporation then it should be standardized for any and all medical doctors/physicians and or medical corporations and made/make public to assist the veteran and not just the LHI corporation.  

VBA-21-8940-ARE.pdf (va.gov)

[brokensoldier244th]

Sorry, I was referring to Section II where the veteran, or provider (I've seen both) list whatever the veteran is claiming for IU. 

 

Forget about LHI- its not an LHI form. I can order an IU exam with an Employment Impact statement from any contract provider or VAMC, provided the VAMC has capacity to do the exam. What you found may have come from LHI but it is not an LHI form, and its not a DBQ, it's an addendum that gets added with a checkbox to be included with a DBQ when it is sent to the provider. A private doctor can write up whatever they want with regards to IU if they have enough information from the veteran to make an assessment with a rationale to support it. 

 

The root form on the site you posted from doesn't list LHI anywhere on it, or it doesn't now. 

https://www.seankendalllaw.net/library/VA-EXAM-MO-re-TDIU.pdf

Edited May 14 by brokensoldier244th

[pacmanx1]

Now let’s put this in a better way for you to understand, since the VA has already made or makes the DBQs available to the public, they should make all addendums available to the public. Below are several DBQs that do not have the addendum part of Individual Unemployability Statement for the private or public medical opinion to address their opinion even though the disability symptoms in each case could likely lead to a veteran’s unemployability. The point to my post is simply that the VA should make the Individual Unemployability Statement available as part of any and all DBQs that could render a veteran Unemployable.  

Mental_Disorders.pdf (va.gov)

Chronic_Fatigue_Syndrome.pdf (va.gov)

PTSD_Review.pdf (va.gov)

ALS_Lou_Gehrigs_Disease.pdf (va.gov)

Heart.pdf (va.gov)