The Veteran you represent may use this Disability Benefits Questionnaire (DBQ) as part of his or her claim for disability benefits from the U.S. Department of Veterans Affairs (VA). Using this DBQ allows the Veteran's licensed healthcare professional to provide VA information it will use to process the claim.
Important: VA will not pay or reimburse any expenses or costs incurred in the process of completing and/or submitting a DBQ. VA reserves the right to confirm the authenticity of all DBQs completed by private health care providers.
Find the appropriate DBQ based on the Veteran's claimed disability.
Submit the DBQ to the Veteran's licensed healthcare professional for completion.
Obtain a copy of the completed DBQ for the Veteran's records.
If the DBQ was completed by a VA provider, skip to step 5.
If the DBQ was completed by a non-VA provider, complete a VA Form 21-4142 for "DBQ Purposes".
(This is so we can request additional information if clarification is needed.)
Submit the completed DBQ to VA.
Veterans Crisis Line:
1-800-273-8255 (Press 1)
U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420
Last updated December 13, 2013