Services

An Independent Medical Exam, or IME, documents your current mental health diagnosis, symptoms, and level of impairment. It helps show what you are experiencing and how your symptoms affect your work, relationships, and daily life.

A Nexus Letter explains the medical connection between your mental health condition and either your military service or another service-connected disability.
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Some veterans need one of these documents. Some need both. The right option depends on what the VA still needs to decide: diagnosis, symptom severity, service connection, secondary connection, aggravation, or unemployability.

An Independent Medical Exam (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.

For VA mental health claims, an IME can document your diagnosis, symptoms, functional impairment, and how your condition affects work, relationships, and daily life. It is similar in purpose to a C&P exam, but it is completed independently and can be submitted as evidence to the VA.

An IME can help when your diagnosis, symptoms, or level of impairment were not fully captured in your VA records or prior C&P exam.

For VA mental health claims, the rating depends heavily on occupational and social impairment: how your symptoms affect work, relationships, judgment, mood, reliability, concentration, and daily functioning.

A strong IME documents those issues clearly and translates your experience into the clinical language the VA uses to evaluate mental health disability claims.

A Nexus Letter is a medical opinion that explains the connection between your mental health condition and your military service or another service-connected disability.

For VA mental health claims, a diagnosis by itself is often not enough. The VA also needs evidence showing why that condition should be considered service-connected.

A strong Nexus Letter reviews the relevant records, explains the medical reasoning, and gives the VA a clear opinion about whether your mental health condition is at least as likely as not connected to service or aggravated by a service-connected disability.

A Nexus Letter should be written by a qualified medical professional with expertise relevant to the claimed condition. For VA mental health disability claims, that usually means a licensed psychologist or psychiatrist.

The strongest Nexus Letters are not just supportive statements. They should review the relevant records, explain the clinical reasoning, address the specific VA evidence issue, and use the correct medical-opinion standard.

For mental disorder claims, the opinion needs to be grounded in psychological or psychiatric expertise, not just general advocacy.

A Nexus Letter can help explain why your mental health condition should be considered connected to your military service or to another service-connected disability.

Some veterans choose to include a Nexus Letter with an initial claim, especially when the connection is complex, not obvious from the records, or involves a secondary condition. Other veterans request a Nexus Letter after the VA denies service connection or misunderstands the evidence.

A strong Nexus Letter does more than state that your condition is related to service. It reviews the relevant records, addresses the specific evidence issue in your claim, and explains the medical reasoning for the connection.

Timelines depend on the service plan and whether your claim requires one phase or multiple phases.

For standard IMEs, your completed DBQ and written clinical summary are typically delivered within one week after your telehealth exam.

For Nexus Letters and other IMOs, you will reserve a delivery date after the required records review or prior phase is complete. Multi-phase plans are structured so you only move forward if the earlier phase supports the next step.

A denial does not necessarily mean your claim is over. It usually means the VA did not have enough evidence to grant the claim based on the records, exam, and medical opinion it reviewed.

The next step depends on the reason for the denial. Some denials involve no diagnosis. Others involve no nexus, a pre-existing condition, an inaccurate diagnosis, or a secondary-claim issue.

The Fieldstone Navigator can help you identify which situation fits your denial and what kind of evidence may be needed next.

The records you need depend on your claim situation. A rating increase requires different evidence than a denied claim, a secondary claim, a pre-existing condition issue, or an Individual Unemployability claim.

In general, useful records may include your DD-214, VA rating decision letters, prior C&P exam or DBQ results, service treatment records, mental health treatment records, relevant medical records, employment records, and personal or buddy statements.

For situation-specific guidance, see the Essential Records Guide: What to Submit Based on Your Situation →

Fieldstone provides telehealth IMEs and Nexus Letters to veterans located in states where Dr. Belanger is authorized to practice through PSYPACT.

Your location at the time of the telehealth evaluation determines whether services can be provided. Current states include: AL, AZ, AR, CO, CT, DE, DC, FL, GA, ID, IL, IN, KS, KY, ME, MD, MI, MN, MO, MS, MT, NE, NV, NH, NJ, NC, ND, OH, OK, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WV, WI, WY.

Because PSYPACT participation can change, please check PSYPACT list of participating states before booking.

Only VA providers or VA contract providers are approved to provide an official compensation and pension (C&P) exam for the VA disability benefits claims. VA contractors are required to follow the same medical training and licensing standards as VA providers.

Being trained, certified, and medically qualified by the VBA means that Dr. Belanger has completed and maintained the qualifications and trainings required to administer Mental Disorder DBQs, Initial PTSD DBQs, and Review PTSD DBQs.

In addition to her standard licensing and training, Dr. Belanger maintains the following VA Examiner Training Certifications:

- DMA Certification
- DMA Initial Post Traumatic Stress Disorder (PTSD) Examination
- DMA Initial Mental Disorders Examination