IMEs & Nexus Letters: Policies and Procedures

Forensic Psychological Services

• It is important for you to understand how these services differ from more traditional psychological services. These services are not psychological treatment and do not establish a treatment relationship.
• Since these are not treatment-related services, they are not part of a health information record and, as such, are not subject to HIPAA rules.
• The purpose of these services is to provide an unbiased and objective evidence-based picture of your claimed disability. As the paying client, you will make the decision on whether to have your Disability Benefits Questionnaire (DBQ) and/or Nexus Letter submitted as evidence for your claim.
• None of these services should be misconstrued as providing you with a determination on your disability claim. All decisions made on your claim are determined by the Veterans Affairs (VA).

Scope of Services:

Independent Medical Examination (IME)
An IME is an exam that is conducted by a medical professional who has never treated you before and has no personal interest in you or in the VA.  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.

Please note that if you are having an IME, the exam may be a stressful time for you.  Many Veterans have increased sadness, anxiety, irritability, insomnia, etc. leading up to the exam, during the exam, and/or after the exam. During the exam, you may take a break at any time and/or you can choose to discontinue the exam at any time.

Records Review
A Records Review involves a thorough review of the relevant documentation you provide, such as your service and treatment records. If you choose to include a Records Review with your IME, your completed DBQ will include references to relevant information from your records.

Nexus Letter
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. 

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.

Record Retainment Policy:

A final copy of the DBQ and/or Nexus Letter will be retained in accordance with applicable laws and regulations. Documents provided for Records Review will be destroyed after the services are completed. 

Confidentiality:

Information acquired during an exam or through a Records Review is confidential and will not be shared without your written permission. However, while conducting an examination, there are certain instances in which your examiner is required by law to disclose information:

• if there is imminent danger to a client or to someone else
• if there is suspected child, elder, or dependent adult abuse
• if records are subpoenaed by court

Telehealth:

Psychologists have a legal and ethical responsibility to make best efforts to protect all telepsychology communications. However, the nature of telecommunication technologies is such that confidentiality cannot be guaranteed.  Encryption methods, firewalls, and back-up systems will help keep your information private, but there is a risk that electronic communications may be compromised, unsecured, or accessed by others.  Fieldstone Counseling & Wellness Services, LLC cannot be held responsible for any breeches of privacy or security that occur during electronic communications. 

Reasonable steps will be taken to ensure your privacy.  You should also take reasonable steps to ensure the security of our communications. (For example, only using secure networks for telepsychology and having passwords to protect the device you use for sessions).  It is important for you to make sure you find a private place for your session where you will not be interrupted.  It is also important for you to protect the privacy of your session on your cell phone or other device.  

Sessions may not be recorded without written permission from all person(s). 

Technological difficulties can occur during the provision of services by phone or videoconferencing. If a session is interrupted/disconnected, we will attempt to reconnect via that medium or by phone (if video isn’t working). 

Treatment Options:

If you are feeling suicidal or overwhelmed, remember you have support available to you 24/7 at the Veteran Crisis Line. Call or text them at 9-8-8.

If you are having a life-threatening emergency, please call 9-1-1 or go to your nearest Emergency Room. 

If you want to receive mental health treatment, you can call any VA medical center or clinic to request an appointment or a referral to a provider in your community. In many instances you can talk with a VA psychologist, psychiatrist, or other mental health professional for free or a low co-pay.