Your patient is applying to the U.S. Department of Veterans Affairs (VA) for disability benefits. VA will use the information you provide on this Disability Benefits Questionnaire (DBQ) to process the Veteran's 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.
If your patient brings the DBQ, go to step 2.
If your patient requests you download the appropriate DBQ based on his or her claimed disability,
|2||Complete the DBQ.
Provide your patient with a copy of the completed DBQ for his or her records.
If you are a VA provider, skip to step 5.
If you are not a VA provider, your patient needs to complete a VA Form 21-4142 for "DBQ Purposes".
If your patient requests, 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 October 22, 2013