Disability Benefits Questionnaires (DBQs) Vet Law Forum 201402 April 2014

CONTROLLED UNCLASSIFIED INFORMATION

DBQ Topics Covered

• Disability Examination Requirements• History of VA Disability Examinations• What are DBQs?• Use of DBQs: VBA, Private Providers, and

VHA Clinicians• Completing a DBQ• DBQs and Advocacy: Helpful Tips

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Disability Examinations and VA Disability Compensation

• VA has a legal “Duty to Assist” Veterans in pursuing claims

• Claim for Service Connection: Triggered when evidence of record shows:• Competent lay evidence or medical evidence of current diagnosed disability or symptoms; • Event, injury, or disease in service OR qualifying service/events to trigger a presumptive

regulation; and• Indication that the claimed disability or symptoms MAY BE associated with service

• McLendon v. Nicholson, 20 Vet. App. 79 (2006)• Low threshold for examination requirement• “May be associated” versus “is associated”• Nexus is not limited to medical evidence

• Claim for Increase: Triggered when medical evidence of record is not current for rating purposes

• Palczewski v. Nicholson, 21 Vet, App. 174 (2007)• The mere passage of time does not make medical evidence “not current”• Does evidence suggest a material change?

• Lay statement can suffice3

VA Disability Examination History

• Legacy Examinations• Narrative format• Standardized examination format• Answer format varied

• August 2009: President Obama’s Innovation Initiative• Reduce time to complete a claim• Improve rating quality• Increase transparency

• Result: Disability Benefits Questionnaires (DBQs)

• Collaboration across multiple VA agencies and offices• Veterans Health Administration (VHA)• Veterans Benefit Administration (VBA)• Board of Veterans’ Appeals (BVA)• Office of General Counsel (OGC)

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What is a DBQ?

• Form designed to collect relevant medical evidence for evaluation of disabilities for VA compensation

• Mapped to VA Schedule of Rating Disabilities (VASRD), found at 38 CFR Part 4

• Addresses legal requirements

• Streamlined, efficient submission of medical evidence

• Standardized format for examination questions and answers

• Forensic medical report

• Condition-specific

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Benefits of DBQs

• Rater-Centric

• Transparency

• Veteran Friendly

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VBA and DBQs

• Regional Office (RO) reviews claim

• Examination threshold criteria and Duty to Assist

• VHA receives examination request

• Examination conducted by VHA• Results recorded

electronically• Transmitted to VBA for review

and rating

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Private Physicians and DBQs

• Veteran downloads paper copy of DBQ form

• Private physician performs examination as necessary

• Results recorded on paper DBQ form

• Veteran submits DBQ to VBA with claim

• VA cannot reimburse for expenses associated with private provider

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VHA Clinicians and DBQs

• Veteran downloads paper copy of DBQ form and presents to VHA Primary Care Provider (PCP) for completion

• VHA physician has several options:• Complete DBQ during scheduled appointment;• Complete DBQ after scheduled appointment; or• Direct Veteran to examination department to schedule

future appointment, if needed

• Veteran retains original DBQ copy

• Completion of DBQ by VHA physician does NOT constitute a claim

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Completing a DBQ: The Process

• Section I: The Diagnosis

• Why is this the first section?• Forensic document to assist in evaluation under VA

regulations

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Completing a DBQ: The Process

• Section II: Medical History

• Subjective report from the Veteran

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Completing a DBQ: The Process

• Physical Examination

• Condition-specific questions

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Functional Impact

• Every DBQ asks whether the Veteran’s condition impacts his or her ability to work

• Clinician should describe the effect on ability to perform occupational tasks due solely to the condition at issue

• What are occupational tasks?• Lifting, walking, bending, prolonged sitting/standing,

repetitive movements• Medical description of abilities, not a legal conclusion

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DBQs and Advocacy

• DBQs for public use:• www.va.gov

Veterans Services Disability Compensation Evidence Requirements DBQ

• DBQ Home Page• Links to DBQ user information• List by form name• List by symptom• How to submit• Instructions for use• FAQ• Link to FDC portal

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Private Provider Completing DBQ?

• Advise Veteran to complete VA Form 21-4142, Authorization and Consent to Release Information for this physician

• Why?• VA can obtain additional information or clarification from provider, if

necessary• Cannot obtain private health data without consent

• Avoid separate VA examination if privately-completed DBQ is unclear and/or insufficient

• Reduce time spent obtaining authorization

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Questions?

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