Abstract: Although research highlights the influence of individual and case characteristics on outcomes of competence to stand trial (CST), mental state at the time of the offense (MSO), and combined evaluations (CST and MSO), we know little about differences in these characteristics across referral type. Using a sample of 2,655 evaluations in Virginia over a 15-year span, we examined demographic, clinical, and legal characteristics associated with whether defense attorneys referred individuals for CST-only, MSO-only, or combined evaluations. Multinomial regression revealed that Non-White individuals and those diagnosed with psychotic disorders were more often evaluated for CST-only, relative to MSO-only or combined evaluations. Individuals with organic or developmental disorders were more often seen for CST-only or combined evaluations. Violent charges were associated with MSO evaluations, either alone or with CST. Individuals who were under the influence of a substance at the time of the offense or had a prior conviction were more likely to be seen for combined evaluations compared to CST-only evaluations. There was more differentiation in CST-only from MSO-only and combined evaluations than from MSO-only versus combined evaluations. Findings are interpreted while considering legal professionals’ potential referral motives. We discuss important implications within the context of fundamental fairness for all individuals in the criminal justice system, particularly given results on racial differences.