United States Department of Veterans Affairs

Veteran Instructions

 

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 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.

Steps

1 Find the appropriate DBQ based on your claimed disability.
2

Take the DBQ to your doctor and have your doctor complete the form.

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