You are using this Disability Benefits Questionnaire (DBQ) as part of your application to the U.S. Department of Veterans Affairs (VA) for disability benefits. For VA to use a DBQ to process your claim, your doctor must provide all requested medical information.
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.
|1||Find the appropriate DBQ based on your claimed disability.
Take the DBQ to your doctor and have your doctor complete the form.
Obtain a copy of the completed DBQ for your records.
If your DBQ was completed by a VA provider, skip to step 5.
If your 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.)
|5||Submit the completed DBQ to VA.|