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Veteran Instructions

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 licensed healthcare professional 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.

Steps

1 Find the appropriate DBQ based on your 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 the DBQ so the licensed healthcare professional can complete it or print the DBQ for your licensed healthcare professional to complete it by hand.
2

Take the DBQ to your licensed healthcare professional and have your licensed healthcare professional complete the form.

  • Your licensed healthcare professional must follow all instructions carefully.
  • Legibility is important! Therefore, VA prefers that your licensed healthcare professional completes the DBQ electronically. If your licensed healthcare professional completes it by hand, please ask him to make sure VA can read the information.
  • Ensure your 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 your records.

4

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.
  • If a VA Form 21-4142 was also completed in Step 4, please submit it along with the DBQ to VA.
  • You or your licensed healthcare professional can fax, mail, or personally deliver the DBQ to the VA Regional Office (RO) responsible for handling you claim. You can find the RO's mailing address and fax number on the DBQ website.

FAQs