Independent Medical Exams (IMEs)
&
Nexus Letters:
How They Can Help You Achieve a Successful Outcome
A successful outcome for a VA Disability Claim includes getting your eligible claim approved AND receiving the appropriate Disability Rating. There’s a big difference between a 30% rating and a 70% rating, and you deserve the rating that is accurate for you. Your rating depends on what symptoms you experience. To see if your rating matches your symptoms, you can look at the rating schedule.
A mental health professional needs to correctly convey three factors to the VA for you to get service-connected and for you to receive an accurate Disability Rating:
- Your mental health diagnosis
- How your mental disorder is connected to your service
- What symptoms you are experiencing
The first two factors determine whether your claim gets approved, and the last factor determines the percentage of your Disability Rating. All three are important.
Hopefully, you can go through the standard VA Disability Claim process and have a successful outcome. That’s the goal. That is also completely free.
There may be situations where your representative recommends that you get an Independent Medical Exam (IME), a Nexus Letter, or both.
Independent Medical Exams and Nexus Letters
What is an Independent Medical Exam (IME)?
An IME is an objective assessment conducted by a medical professional who has never treated you before and has no personal interest in you or in the VA. The medical professional may review your documentation, such as your service and treatment records, in addition to conducting their examination. (You may also hear people refer to these as DBQs or C&Ps.)
An IME is similar to what you may experience in a C&P exam through the VA. If you get an IME through Fieldstone Counseling & Wellness Services, this is what you can expect.
In the examination, you will be assessed for a possible mental disorder. After the examination, the pertinent DBQ will be completed and provided to you. You will make the decision whether to have it submitted as evidence for your claim.
You will be given questionnaires/assessments to complete and return prior to your exam. Exams are conducted through telehealth only and will be scheduled for an hour.
How can an IME help my claim?
IMEs can be helpful in conveying your mental health diagnosis and what symptoms you are experiencing. Therefore, you might want one if your claim was denied or if your claim was approved but your Disability Rating was lower than it should be.
What is a Nexus Letter?
A nexus is a connection or link between two or more things. A Nexus Letter is a document that explicitly connects an in-service event or an established service-connected disability to the current condition for which a veteran is seeking service-connected compensation. (You may also hear people refer to these as Independent Medical Opinions or IMOs.) The author of a Nexus Letter must be an expert. The gold standard for opinions related to mental disorders requires either a psychologist or a psychiatrist.
In order to write the Nexus Letter, you will need to provide medical documentation of your diagnosis/diagnoses. If you do not yet have a documented mental disorder diagnosis, you will need to have an IME first to determine any diagnosable mental disorders.
The Nexus Letter will be written based on information obtained during your Records Review. Therefore, a Records Review is required for any Nexus Letter. If after completing your Records Review, it is determined that a positive opinion cannot be offered in a Nexus Letter, you will be informed that a Nexus Letter cannot be written. In such an instance, you will be refunded the fee for the Nexus Letter. The Records Review fee is non-refundable.
How can a Nexus Letter help my claim?
Nexus Letters provide vital context in showing how a mental disorder is either directly related to your service (Direct Service-Connection) or related to a different service-connected disability (Secondary Service-Connection). The link between two events/disabilities is not always clear. Dr. Belanger has the expertise to identify service-connection and to present evidence according to the VA’s standards.
Two Types of Service-Connection
There are two types of service-connected disabilities: direct and secondary.
Direct Service-Connection
A direct service-connection refers to a condition that began while a veteran was on active duty. For most mental disorders, your Service Treatment Records (STRs) will need to contain documentation to show a direct service-connection.
PTSD is the only mental disorder that may be granted as service-connected without clear documentation in your STRs. Learn more about PTSD claims and how Nexus Letters can help.
Secondary Service-Connection
A secondary service-connected condition is an injury or illness that is a result of a direct service-connected condition.
For example, you may have service-connected chronic back pain. If, as a result of the chronic back pain, you have developed a depressive disorder, that would be considered a secondary service-connection.
Gain control over a process that feels beyond your control.
Bringing competence and compassion to IMEs.
Why should I choose to go to Dr. Belanger for my IME and/or Nexus Letter?
- Choosing any examiner for an IME gives you more control over a process that feels mostly beyond your control.
- As a VA-approved examiner, Dr. Belanger can successfully complete the IME and Nexus Letter to the VA’s standards.
- Dr. Belanger will guide you through the exam process to ensure that she is accurately portraying your symptoms and your level of impairment.
- Dr. Belanger will conduct your assessment in the context of prioritizing your needs and well-being. That means that in addition to providing an assessment that is objective and accurate, your examination will be trauma-informed, culturally sensitive, and compassionate.
- You can complete the exam from the comfort of your home. No need to go anywhere. Exams are all provided through telehealth.
Do I need to know my diagnosis already?
No. For an IME, Dr. Belanger will evaluate your symptoms and if you meet the criteria for a mental health diagnosis, she can determine that diagnosis and provide you with appropriate documentation for the VA.
If you need a Nexus Letter and you already have documentation of your diagnosis, you can provide that documentation to Dr. Belanger, or if you don’t yet have a diagnosis, she can write a Nexus Letter after completing your IME.