Get a Nexus Letter from a psychologist

Some reasons you might want a nexus letter/ independent opinion from a psychologist:
  • establishing a direct service connection for mental health concerns (ex: PTSD, depression, anxiety) or a TBI
  • establishing a service connection for other problems related to your mental health concerns (ex: sleep apnea due to PTSD)
  • establishing service connection for mental health concerns secondary to an already service connected problem (ex: depression due to a service connected tinnitus)
  • a potential increase/ unemployability
  • Have questions? Call Dr. Finnerty: (330)495-8809

Psychologist Nexus Letters and/or Independent Medical Opinions for Veterans

Dr. Todd Finnerty is a psychologist and he provides file reviews for Veterans on their VA disability claims. He is also able to perform examinations (including completing a DBQ). This website is maintained by Dr. Finnerty.
I am a licensed psychologist based in Columbus, Ohio. I perform independent examinations and records reviews for independent medical opinions on Veterans'disability cases. I offer:
  • Predictable flat rate pricing
  • Detailed reports that address all the evidence
  • The benefit of my experience (I have performed many file reviews on disability cases as well as compensation and pension examinations).

In addition, you won't have to send paper records to me or mail a CD or flash drive if you don't want to. I offer HIPAA-compliant online file-sharing solutions. You can also exchange encrypted emails with me without needing to set up encrypted email yourself. Learn more about that here.

The following fee schedule for records reviews includes answers to whatever referral questions are necessary (ex: a nexus letter opinion). This is my case rate pricing (meaning there are no additional fees beyond this):

  • $600 per case
  • For Dr. Finnerty to perform a file review for you you can be located anywhere in the world.
  • My case fee for larger files used to be $900 for cases with 1,001 to 1,499 pages and $1,500 per case for claims files with 1,500 pages or more, however I am not currently charging these fees. I am only charging $600 regardless of the number of pages-- this is a temporary discount through May 2020 due to COVID-19.

My in-person exam fee (includes a records review, a detailed report and a DBQ form) is:
  • $900
  • Exams take place in person in Columbus, Ohio

To learn more about my fees and to find answers to other commonly asked questions see my FAQ page. I accept checks and credit card payments can also be made directly on my website here.


Do you "rubber-stamp" disability cases and say everyone qualifies?

Is my job to help any Veteran that pays me win their disability case? No. I offer an independent opinion. If I agree your claim has merit then I will write a report that helps with your case. There is a chance that you may pay me for an exam or a file review and I may not agree with a medical nexus or other disability-related questions you have. However, to reduce the chances that you'll spend money unnecessarily I try to vet claims in advance and only accept claims that I believe may have merit. I also will not ask for a percentage on anything you earn nor is my compensation based on the outcome of your claim. I'm not paid based on the opinion I give; you may pay me and I may then review your records and find that your claims aren't supported. This approach is consistent with my ethical guidelines.

I don't charge separate fees for records reviews and opinions (reports/nexus letters). The fee includes reviewing the records and writing the independent medical opinion report/ nexus letter.

Will you conduct a telehealth examination and complete a Disability Benefits Questionnaire (DBQ)?

No, Dr. Finnerty will only complete a DBQ for an in-person examination (and you may not want to pay any private, non-VA individual to do this at this time unless your attorney suggests it). This is because certain VBA policies do not look kindly on these examinations. For example, read "Telehealth Public-Use Questionnaires Were Used Improperly to Determine Disability Benefits" and also this related article from Military.com "Granting VA Disability Claims by Remote Questionnaire Led to Fraud, Report Shows." Dr. Finnerty is willing to perform a records review for you remotely.

When should a referral for an independent medical opinion and/or nexus letter be made to you?

Dr. Finnerty does not want you to spend your hard-earned money unnecessarily. If you have an attorney or VSO it is a good idea to speak with them to determine whether they think an independent file review or examination would be beneficial to your claim. If you have not yet had a compensation and pension exam through the VA you should wait and go to that exam first (you may not need a records review or an independent exam if things go well on your claim).

How long do you take to write a report/ nexus letter?

I try to have a report completed within 2 to 3 business days of receiving the claims file. For claims files with many thousands of pages it may take longer.

Are there common errors you see in VA disability cases?

Dr. Finnerty has performed a number of file reviews on Veterans' disability cases as well as performed compensation and pension examinations. Some of the errors Dr. Finnerty sometimes sees in the file include disability examiners discounting a Veteran's stressor for the purpose of a PTSD diagnosis. This will lead them to say that they don't meet the A criterion for PTSD when in fact their traumatic stressor does qualify under DSM-IV and DSM-5. Other errors that examiners may make include not thoroughly reviewing the background records and missing psych-related complaints that occur during the military. They may also not give sufficient consideration to behavioral markers around the time of discharge such as discipline problems or legal difficulties, anger problems and fights, substance use to self-medicate and similar concerns. In addition, disability examiners may place an undue emphasis on the validity scales of psychological tests like the MMPI-2 or MMPI-2-RF. This may lead them to make the error of ignoring or disregarding other evidence in the file without proper consideration, particularly when other explanations may exist for the elevated validity scales such as making a "plea for help." They may also use the wrong burden of proof such as "high scientific certainty" instead of "at least as likely as not."

Should nexus letters/ IMO's be brief?

The summary synopsis for the opinion should be brief and should emphasize the important points of the case. The opinion needs to be readable and focused; concise is good for that. There is also not much point in simply rehasing the evidence in a long, drawn-out narrative without providing an analysis of that evidence. However, opinions that are too brief fail to provide sufficient support for the conclusions. They don't reflect that the consultant considered all of the relevant pieces of evidence. This could cause problems. My reviews include brief summaries which emphasize the important points, but they also provide multiple pages where I address all of the key evidence in the file. I say why some things in the file are consistent with the evidence when they are supported and I say why they aren't consistent when they are not. I address each important piece of evidence in the file, such as an unsupported opinion, and describe why it is not supported and not consistent with the evidence. You don't want to pay for a consultant who will simply be brief; you want a consultant who will show their work and support the conclusions they arrived at.

Can you tell me more about how you approach a claim?

I've been performing records review work since 2004. I am comfortable offering definitive opinions rather than wishy-washy statements. I offer a firm conclusion based on my review. I also don't go on tangents or offer irrelevant or speculative opinions. My opinions relate directly to the referral questions I'm given and I back those opinions up with the evidence in the file. I try to be specific whenever possible and avoid vague or confusing language. I try to offer opinions which are readable and understandable to people who aren't psychologists. I do use the appropriate standard for my opinion such as whether something is at least as likely as not.

Please feel free to reach out to me with any questions you may have or to schedule a records review or an examination.


Want a free brief case consultation? Call Dr. Finnerty's cell (330)495-8809, email him or send your contact information with the form below:


Nexus Letters Blog at NexusLetters.com

I recently started a new blog at NexusLetters.com; I plan to write about relevant news and resources for people interested in VA disability claims. There is also an email mailing list you can sign up for there to receive relevant news and resources directly in your email.


Return to Dr. Finnerty's main page.