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Inquiry reason

Referral source

Enter how you were referred to our services

Driver's license upload

Do not upload sensitive financial information such as credit card information.

Military / Veterans seeking Independent Medical Exam.

Current Diagnosis: Do you have a current, formal mental health diagnosis, or are you experiencing active psychiatric symptoms?

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The In-Service Event: Can you point to a specific event, injury, illness, or stressor during your military service that caused or triggered this mental health condition?

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Service Treatment Records (STRs): Did you seek mental health treatment while on active duty? If yes, is it documented in your military records?

Secondary Connection: If your mental health condition is caused by a service-connected physical injury (e.g., chronic severe back pain or tinnitus causing depression/insomnia), is that physical condition already officially rated by the VA?

Limited to 600 characters

Current Treatment: Are you currently seeing a therapist, psychologist, or psychiatrist, or taking psychiatric medications? (Longitudinal civilian records heavily strengthen a DBQ).

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Which branch did you serve in?

Army Air Force Navy Marine Corps Coast Guard National Guard Reserves

Dates of Service

Type of Discharge

Honorable General Other than honorable Dishonorable Bad conduct

Were you deployed?

Is your claim:

Initial claim Supplemental claim Higher-Level Review Board Appeal Increase in disability rating Reduction appeal

Current combined VA disability rating:

Conditions You Want Evaluated

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Has another provider previously completed a DBQ?

Has another provider written a Nexus Letter?

Please indicate which records you can provide.

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Have you been denied by the VA for this condition before? If yes, why do you believe the claim was denied?

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