Veteran Service Organization/Power of Attorney Instructions

• Go to http://www.vba.va.gov/disabilityexams
• 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  doctor can complete electronically or print the DBQ so the Veteran's doctor can complete it by hand.
  

• The doctor must follow all instructions carefully.
• Legibility is important! Therefore, VA prefers that the doctor complete the DBQ electronically. If completed by hand, please ask the doctor to make sure VA can read all the information.
• Ensure the doctor 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 doctor. A doctor completing an electronic DBQ must print it to sign it.
  

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.)

• Open Authorization and Consent to Release Information.
• Fill out the medical provider information.
• Indicate "For DBQ Purposes Only" under Comments in Box #9.
• Save and print the form.
• Have the Veteran sign the form.

• You, the doctor, 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.