What to Know about VA Disability Claims and Fraud

Joe Wallace

Getting VA disability compensation from the Department of Veterans Affairs can be complicated. Newcomers to the process soon learn that at its center is a document known as the VA Disability Benefits Questionnaire, or DBQ.

Designed to standardize medical evidence, the DBQ is the primary tool the VA uses to determine the severity of a veteran’s service-connected condition.

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What to Know about VA Disability Claims and Fraud

The VA Disability Benefits Questionnaire is a standardized medical form created by the VA to ensure that clinicians capture the specific information needed to rate a disability.

Before the introduction of these forms, medical evidence often arrived in the form of handwritten notes or disparate hospital records, leaving VA “raters” to hunt for specific data points—such as range of motion or frequency of symptoms—required by federal law to assign a percentage.

There are currently more than 70 different DBQs available, each tailored to a specific medical category. Whether a veteran is claiming a heart condition, post-traumatic stress disorder (PTSD), or a knee injury, there is a specific DBQ for the right clinical data. This standardization is intended to speed up decision-making by providing the VA with what it needs in a predictable format.

How the Process Works

A DBQ is filled out during your Compensation and Pension (C&P) examination conducted either by a VA staff physician or a contracted private medical provider. In these cases, the veteran does not need to bring the form; the examiner completes it digitally and submits it directly to the VA at no cost to the veteran.

Alternatively, veterans can have their private physician complete a “Public DBQ,” but the VA does not reimburse veterans for any fees a private doctor may charge to complete these forms, and the veteran is responsible for ensuring the form is manually uploaded to their claim file.

The VA is strict about who can sign off on these documents. A DBQ is typically completed by a licensed medical professional with the appropriate credentials for the condition being evaluated.

While general conditions can often be handled by a Medical Doctor (MD), Physician Assistant (PA), or Nurse Practitioner (NP), certain claims require specific expertise. For instance, an initial exam for Traumatic Brain Injury (TBI) must typically be performed by a specialist.

Rising Fraud

The VA has issued warnings regarding DBQ fraud and scams. Unscrupulous companies, sometimes called “claims sharks,” target veterans by promising guaranteed increases in VA disability ratings in exchange for fees or a percentage of veterans’ future backpay. In recent times, reports of these scam attempts have increased.

According to VA guidance, these predatory entities often use aggressive marketing to convince veterans that the standard VA process is broken and that only their help can get them a higher rating.

This is not only misleading but can lead to a veteran’s claim being flagged for fraud if the medical evidence provided is found to be rubber-stamped or generated without a physical examination. The same is true when the veteran is encouraged to report symptoms or conditions that don’t accurately reflect the veteran’s medical condition.

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Red Flags of DBQ Scams

To protect the integrity of the benefits system, the VA identifies several warning signs that a veteran might be dealing with a fraudulent entity:

• No one can guarantee a specific disability rating, as only the VA has the legal authority to assign ratings.
• Be wary of anyone who asks for a portion of your future benefits or charges high upfront fees for a DBQ.
• Avoid companies that provide completed DBQs after only a brief phone call or without a thorough review of your official military medical records. Authentic DBQs require a legitimate clinical nexus.
• Veterans should never share their VA.gov login credentials or agree to have their benefits deposited into a third-party’s bank account.
• Consultants who advise veterans to skip a VA-scheduled C&P exam are putting the veteran’s claim at risk, as skipping these appointments is a primary reason for an immediate claim denial.

How to Protect Your VA Disability Claim

Work with a VA-accredited Veterans Service Officer (VSO), accredited attorney, or accredited claims agent. These are vetted by the VA and are subject to rules regarding what they can charge for their services. They provide a layer of protection against the predatory practices of unaccredited consultants.

If a veteran chooses to use a private doctor for a DBQ, they should ensure the doctor is truly treating them for the condition and is willing to stand by the medical opinions provided.

The VA continues to emphasize that while they value evidence from private treatment providers, they want veterans to stay alert to companies marketing the completion of DBQs as a shortcut to higher compensation.

Do you suspect you have been targeted by scammers or have been encouraged to submit a DBQ that does not reflect your medical reality? Report any suspicious activity to the VA Office of Inspector General to help track and shut down predatory operations. The Federal Trade Commission also handles fraud reports and can help protect others from falling into the same trap.

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