Update 12/14/2021: The last approximately two months or so I’ve been prioritizing getting caught up on records review based nexus letters (without exams). It has been taking me around 3 to 4 weeks to get records review based nexus letters back to people and I’d like to get them back sooner than that. Since exams and writing reports and DBQ’s can be even more time-intensive which significantly reduces the time I have to write the other nexus letters based on records reviews, I have delayed scheduling more exams and announced that the price of exams (but not the records review nexus letters for secondary conditions) will be increasing in 2022.
I now estimate that I will start scheduling a limited number of exams beginning in February 2022 (but only a relatively small number per month). Be advised that at certain times of the year, every year, I will not schedule any exams for a large block of time in order to ensure that I do not get further behind than 3 to 4 weeks on records review based nexus letters (and to do things like take a vacation or visit family for the holidays). Therefore, if you’d like to try to get an exam from me, you’re advised to try to plan ahead well in advance of when you think you might need it. However, I know that sometimes things come up with a tight deadline such as the VA proposing a reduction in your rating. One difficulty I’ve also had in the past was people scheduling exams with me very far out (ex: two months out) and then telling me just before the appointment that they didn’t need or want the appointment anymore (with no real time for me to get someone else into that appointment slot). To try to address this, and to encourage people to perhaps explore other options besides getting an exam from me, I am going to experiment with various policies. I’d be happy to have your thoughts on them. One policy I’m considering is not scheduling any exams further out than 45 days (I may experiment with the exact number of days based on the results and may possibly even shrink this to 30 days). This will be reflected in the online scheduler I use from my website and will be enforced automatically as the scheduling system will not offer the appointment on the calendar until 30-45 days prior to the day of the appointment (I won’t be making any exceptions for people who try to call or email to make appointments in order to ensure fairness related to this policy).
I’m also considering some other policies that will impact who I see for exams. Truthfully, there is a significant need out there and I could probably stay busy with just exams from morning until night, but that would significantly negatively impact my other obligations (I don’t have the available time to see everyone I’d like to be able to see or who’d like to be able to see me truthfully). So, I’m considering adding somethings to help triage the cases and perhaps keep slots free for the neediest and/or “hardest” cases. I am not sure what the best way to do this is. One thing I’m considering is having a prerequisite– a condition you meet prior to scheduling– of you having started in treatment for the mental health condition before coming to an exam with me (though I know it isn’t always easy to get into treatment quickly, especially if your resources are limited). I’m considering this because sometimes people come to me with the primary motivation of establishing a diagnosis for the condition which they want to get service connected (sometimes in part because they then want to pursue treatment for it, etc.). However, I’d like to encourage you to not wait to pursue options for treatment for your conditions. I only provide a one-time exam, not treatment, and you can get a diagnosis by pursuing treatment and could potentially get in to see someone sooner. A good place to start if you’re not sure where to start is to go to your primary care physician (or get a primary care physician if you don’t have one) and ask about referrals to mental health professionals who have experience working with Veterans (the VA of course is a potential option to consider). I’m considering making pursuing treatment for the condition or having pursued treatment for the condition already in the past a prerequisite for scheduling an exam with me (your treatment provider may have given you a diagnosis that you don’t agree with– that’s okay– I would still consider the treatment requirement met for the purpose of scheduling an exam).
While not a prerequisite at this point, I think I will at least also prefer it if you’ve already been to one C&P exam at some point in the past for the psych condition you’re filing for. I understand that people have hopes of avoiding a C&P exam altogether or hopes of impacting the C&P exam with the exam they do with me because they don’t trust the examiners that the VA sends them to. I think this fear can be fueled by lots of horror stories online and perhaps bad experiences that people have already had. I’ve personally seen plenty of terrible opinions from C&P examiners, but there are good C&P examiners too. I used to be a C&P examiner myself through both QTC and VES. This didn’t make me a terrible and untrustworthy tool of the government at the time– at least I hope it didn’t– and I’d probably still do that work if the third party contractors themselves weren’t so annoying to work with. My thought in relation to preferring, but not requiring, that you’ve already been to one C&P exam for the condition is that: (1) It suggests you already have a diagnosis/treatment related to the condition you’re filing for service connection for since the VA probably wouldn’t have sent you for an exam otherwise and (2) It may actually be worth it to you to get an independent exam (not just because of fears of what a C&P examiner may or may not say). I say this because assuming you have a diagnosis (ex: from your treatment provider) for the condition you’re filing for the VA will likely pay for an exam to complete a DBQ (the C&P) which helps determine if there is a service connection and the rating. You wouldn’t have to spend your own money. I do understand if you want to pay for an independent opinion even prior to going to a C&P examination, but in terms of prioritizing/triaging who needs to get a time slot with me, at times I may need to prioritize the “harder” or “needier” cases where there was a terrible opinion from a C&P examiner (yes, this does happen) which needs to be addressed by an expert. Since I don’t have time to see every Veteran that would like to have an exam from me, I think it makes sense to try to somehow prioritize the cases that are perhaps most in need of an exam- though I recognize that there is no perfect way of doing this. I do know though that sometimes while we may think the VA should have scheduled a C&P for you, for whatever reason they don’t, so I won’t require you to have attended a C&P already before seeing me.
If you have thoughts, ideas or suggestions related to this please let me know. If you need to schedule an exam before February 2022 (beginning in February 2022 there will also likely only be a very small amount of availability for exams at first as well) remember there are other psychologists and psychiatrists that do this work, some of them are on the list on this website.
In the meantime, if you need a nexus letter based on a records review (especially for secondary conditions to something you already have service connected such as sleep apnea secondary to PTSD) I am still accepting these cases and quoting that it will take approximately 3 to 4 weeks to get the nexus letter back to you.
Thank you,
Additional update 12/20/2021: A limited number of exam appointments are rolling out for February 2022. Exam appointments will first appear on the schedule 45 days out from the day of the exam (although at times I might also experiment with 30 days). There also will be times each year such as around the holidays and stretches of time in the Summer when there will be no exams available, so please plan ahead if you want an exam from me. Thank you.