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Compensation

Veteran Service Organization/Power of Attorney Instructions

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.

Steps

1

Find the appropriate DBQ based on the Veteran's claimed disability.

  • Go to http://benefits.va.gov/COMPENSATION/dbq_disabilityexams.asp
  • Select the appropriate DBQ by using the "List by DBQ Form Name" or "List by Symptoms" web pages.
  • Either download a digital version of the DBQ that the Veteran's licensed healthcare professional can complete electronically or print the DBQ so the Veteran's licensed healthcare professional can complete it by hand.
2

Submit the DBQ to the Veteran's licensed healthcare professional for completion.

  • The licensed healthcare professional must follow all instructions carefully.
  • Legibility is important! Therefore, VA prefers that the licensed healthcare professional complete the DBQ electronically. If completed by hand, please ask the licensed healthcare professional to make sure VA can read all the information.
  • Ensure the licensed healthcare professional completes the last section of the DBQ by providing his or her name, signature, and contact information. VA will only accept a DBQ signed by a licensed healthcare professional. A licensed healthcare professional completing an electronic DBQ must print it to sign it.
3

Obtain a copy of the completed DBQ for the Veteran's records.

4

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.)

5

Submit the completed DBQ to VA.

  • You, the licensed healthcare professional, or the Veteran can fax, mail, or personally deliver the DBQ to the VA Regional Office (RO) responsible for handling the claim. You can find the RO's address and fax number on the DBQ website.

FAQs