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Nexus Letters and/or DBQ’s for VA Disability Claims

Do you need a nexus letter? You’ve come to the right place. Dr. Todd Finnerty is a psychologist who writes nexus letters. He also performs independent exams for Veterans’ disability claims (including DBQ forms).

At Veterans can get a nexus letter from a psychologist based on a records review for $600 for secondary conditions that involve a psychological issue. This is the entire fee- there is no other fee unless you want a DBQ and/or an exam. For example, if you are filing for sleep apnea secondary to PTSD, depression, anxiety or another psychological condition, the total cost would be $600 (this would include a records review and nexus letter; if you want a DBQ there is an additional fee).

If Veterans need a mental health diagnosis or are filing for a rating increase for PTSD or other psychological conditions, they can attend a telehealth exam and get a diagnosis, records review, nexus/ medical opinion and DBQ for $1,500 total.

Dr. Todd Finnerty is a psychologist and disability claim expert motivated to ensure that people get the help they qualify for and don’t fall through the cracks in the system. One way Dr. Finnerty helps others is by writing nexus letters for Veterans. Dr. Finnerty is available to write Nexus Letters and/or Independent Medical Opinions for Veterans who need them.

Dr. Finnerty is a forensic specialist and adheres to the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct as well as the APA’s Specialty Guidelines for Forensic Psychology ( These guidelines include the responsibilities of integrity, impartiality and fairness and note: “When offering expert opinions to be relied upon by a decision maker, providing forensic therapeutic services, or teaching or conducting research, forensic practitioners strive for accuracy, impartiality, fairness, and independence. Forensic practitioners recognize the adversarial nature of the legal system and strive to treat all participants and weigh all data, opinions, and rival hypotheses impartially. When conducting forensic examinations, forensic practitioners strive to be unbiased and impartial, and avoid partisan presentation of unrepresentative, incomplete, or inaccurate evidence that might mislead finders of fact. This guideline does not preclude forceful presentation of the data and reasoning upon which a conclusion or professional product is based.” is a website operated exclusively by psychologist Todd Finnerty, Psy.D.; the only person who writes nexus letters at is Dr. Finnerty. As a service to help you find a nexus letter there are also links to other professionals on this website (including to physicians). These are to assist you in case you need to find someone other than Dr. Finnerty (ex: for an issue that Dr. Finnerty doesn’t specialize in). does not contract to have outside professionals do any of the work; the only person writing nexus letters at is Dr. Finnerty. If you are looking for a nexus letter for a medical condition that you need a physician to write a nexus letter for you should contact a physician such as one at the provided links on this site for a nexus letter from a physician.

Keep in touch:

Dr. Finnerty writes an occasional free email newsletter where he provides updates about his practice at as well as his thoughts about issues related to VA disability cases. You can subscribe to that here: Free E-mail Newsletter- Subscribe! – Nexus Letters from a Psychologist

@NexusLetters on YouTube:

YouTube: Dr. Finnerty also occasionally posts videos and you can subscribe at

No appointment needed many times

For many secondary conditions like sleep apnea secondary to PTSD or other psychological conditions, you won’t need to attend an exam with Dr. Finnerty. Dr. Finnerty can often write a nexus letter for secondary conditions by reviewing your medical records.

Typical secondary nexus letter topics Dr. Finnerty will address for $600:

  • Sleep apnea secondary to PTSD (or other mental health conditions)
  • Migraines secondary to mental health conditions
  • Gastrointestinal issues like GERD & IBS secondary to mental health conditions
  • Hypertension secondary to PTSD (and other mental health conditions)
  • Mental health conditions like depression and anxiety due to tinnitus
  • Depression, anxiety, etc. due to physical conditions that cause chronic pain
  • Others by request assuming they involve a psychological condition
  • Note that this assumes that the condition you are trying to service connect the new condition to has already been diagnosed and service connected (for example, if you are trying to service connect sleep apnea secondary to PTSD the assumption of the price above is that PTSD has already been diagnosed and service connected. Dr. Finnerty does not work on new PTSD cases or PTSD increases just based on the $600 records review fee- an exam is typically required for that).

Nexus Letter topics Dr. Finnerty WILL NOT address: Dr. Finnerty won’t write a nexus letter for physical conditions secondary to physical conditions or anything else that doesn’t involve a psychological issue. For example Dr. Finnerty doesn’t write nexus letters for sleep apnea secondary to tinnitus or rhinitis or burn pits, etc. For this you’d want to find a more appropriate specialist; you can try this list of doctors who write nexus letters.

Dr. Finnerty also does NOT complete VA Aid and Attendance forms.

DBQ’s: The ONLY DBQ’s Dr. Finnerty completes are the psychology-related DBQ’s (ex: a PTSD DBQ or Mental Disorders DBQ) after completing an exam. Dr. Finnerty is currently willing to complete a sleep apnea DBQ based on a records review. However, Dr. Finnerty does NOT complete any other type of DBQ as they are not in his area of expertise.

Do you need an initial service connection/ rating or VA disability increase for a psychological condition (ex: a rating increase for PTSD)? Dr. Finnerty may be able to help with an independent examination and DBQ.

DBQ exams for mental health conditions (telehealth or in-person- $1,500)

Dr. Finnerty does schedule a very limited number of exams for DBQ’s on mental health disability claims (exams cost $1,500 total with the records review and DBQ included in that price). Please do not schedule an exam without first receiving permission from Dr. Finnerty to schedule (such as in an email from Dr. Finnerty). Also note that Dr. Finnerty often does not have immediate availability for examinations so please plan ahead if you feel like you’ll need to schedule an exam. If Dr. Finnerty doesn’t have availability you can also consider a different psychologist such as one on this list.

Are you looking for an exam related to a service connection for a mental health condition like PTSD or an increase in your service connected PTSD, depression, anxiety or other mental health condition? Do you need a diagnosis or want Dr. Finnerty’s opinion on whether or not you have somatic symptom disorder or another psychological condition caused by chronic pain or other service connected physical conditions? Do you disagree with the diagnosis or opinions from the VA’s C&P examiner?

Dr. Finnerty is a former C&P examiner for both QTC and VES. Dr. Finnerty understands what is needed in a VA claim. He can provide an examination and medical records review in order to offer his independent opinion related to your VA disability claim. You may also wish to schedule an exam for a more detailed opinion and DBQ for psychological issues secondary to service connected medical conditions rather than just having Dr. Finnerty perform a records review.

Add on Sleep Apnea DBQ (an additional $160)

Dr. Finnerty writes nexus letters for sleep apnea secondary to psychological conditions like PTSD; this service costs $600. A sleep apnea DBQ is not necessary for this, and C&P examiners will complete the sleep apnea DBQ at no charge to you, but sometimes Veterans want Dr. Finnerty to also complete the sleep apnea DBQ. Due to the additional time involved, Dr. Finnerty now charges his brief form completion fee for this service if you want a sleep apnea DBQ in addition to your nexus letter. Please keep in mind that Dr. Finnerty is a psychologist and the VA rater may or may not accept Dr. Finnerty’s DBQ and opinion. You’d pay the $600 nexus letter fee then also pay the $160 fee in addition if you wanted the DBQ (again, the DBQ is not necessary for the nexus letter and there should be no expectation that the VA would not also order a C&P examination to have their examiner also complete a DBQ). Dr. Finnerty will complete the DBQ via a records review– not an exam– and the form completion will be limited by what is available in your records. Having a copy of your sleep study is necessary for this service; Dr. Finnerty is not able to order a sleep study or diagnose sleep apnea.

Note: Dr. Finnerty does not complete DBQ’s for other physical conditions.

Can getting a private DBQ benefit you?

If you haven’t had a C&P before (or don’t agree with the ratings on a psych-related DBQ), getting a DBQ from Dr. Finnerty could potentially be beneficial. There is a possibility you wouldn’t need to attend another examination (but not a guarantee). For example, the VA’s policy notes:

IV.i.1.B.1.h. Using Medical Evidence in Lieu of Examination
As noted in 38 CFR 3.326 and M21-1, Part IV, Subpart i, 1.A.1.c, medical evidence of record may be deemed adequate for rating purposes to make a decision on a claim without requesting an examination.

Generally, in claims for SC, for medical evidence of record to be considered adequate for rating purposes, the evidence must include sufficient details to establish both SC and the current level of disability. If the evidence of record includes information sufficient to grant SC, but there is a question as to the appropriate evaluation, an examination would generally be needed prior to deciding the claim.

Use the below guidelines to determine if evidence of record can be used to decide a claim in lieu of requesting an examination. These guidelines should be applied to claims for SC where a nexus opinion is not needed (for example, with presumptive SC) and claims for increase.
Do not routinely request an examination if a claim is accompanied by
a disability benefits questionnaire completed by a private or VA physician, or
medical evidence that is otherwise adequate for rating purposes
as defined in 38 CFR 3.326.

Which states can Dr. Finnerty provide telehealth visits to?

Dr. Finnerty can perform records reviews for anyone anywhere, however there are some states where he is not able to do telehealth exams. Dr. Finnerty resides in Ohio where Dr. Finnerty is licensed as a psychologist (#5979) and can see anyone located in Ohio with this license. Dr. Finnerty offers a telehealth option to Ohio and a large number of other states where Dr. Finnerty can legally examine someone via telehealth. He can do this as he is a PSYPACT provider (the PSYPACT link has a map of states where Dr. Finnerty can offer telehealth exams under PSYPACT). In some states he can also apply for temporary permission to practice with the psychology board in that state. Dr. Finnerty also is a registered telehealth provider in Florida and can provide psychological services to individuals in Florida via telehealth. Dr. Finnerty’s Florida telehealth provider registration number is #752. Learn more here:

How do you get a nexus letter from Dr. Finnerty? Follow this link for a quick overview of How it works:

The Value of working with Dr. Finnerty

Learn about the Value of working with Dr. Finnerty here:

For questions related to VA disability compensation rates you can view the VA’s website:

How long will it take to get your nexus letter?

If you need a nexus letter please plan ahead. It could take up to a month. Learn about how long it takes here:

Free E-mail newsletter- subscribe and read excerpts from 50+ claim approvals relevant to sleep apnea secondary to PTSD (and other psych conditions)

Now and then Dr. Finnerty will send out an e-mail newsletter with information about his practice or an interesting news item relevant to Veterans’ disability claims. When you subscribe to the newsletter you’ll receive an email with a link to excerpts from 50+ claim approvals from the BVA related to sleep apnea secondary to PTSD and other psychological conditions. Just enter your email below:

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Contacting Dr. Finnerty

Advisory: Sometimes Dr. Finnerty’s emails have been ending up in the spam folder so if you’re expecting an email from him you might want to check the spam folder now and then; thanks. Dr. Finnerty gets a lot of email and it can take some time for him to respond to it all. However, he may miss an email from time to time so if you think this happened please feel free to send it again (remember you can also sign up for a free phone call appointment with him where you will be sure to speak with him directly).

E-mail encryption: Dr. Finnerty will typically send emails using Microsoft 365 Encryption- especially when reaching out to you for the first time or when sensitive information is involved. If you prefer not to receive them this way let him know. Here is some more information from Microsoft on tips related to opening the message if you are having trouble.

You can learn more about Dr. Finnerty here.

Do you still have questions? You can read answers to frequently asked questions here:

Please note: Dr. Finnerty is NOT a VA Accredited Representative and does not and can not give general advice related to filing your claim, etc.; you can learn more about reps here: and here:

Here is a page from the VA about avoiding fraud targeting Veterans: Protecting Veterans From Fraud | Veterans Affairs (

Here is a page from the VA: “How To File A VA Disability Claim | Veterans Affairs.”

IMPORTANT note about phone messages to Dr. Finnerty: Dr. Finnerty is currently using Ruby Receptionists to answer his phone calls. While you can leave a message with them, it may take some time before Dr. Finnerty actually sees that message. If you want a phone call back from Dr. Finnerty you must schedule that call back here:

At times Dr. Finnerty’s email inbox and list of phone messages becomes unruly and he may miss a message, sorry. Please feel free to reach out again if you haven’t heard from him. You an also schedule a phone appointment to speak with him using the online scheduler.

Additional contact details can be found here:

The form below is the best and preferred way to contact Dr. Finnerty for the first time about a nexus letter or exam:

Referral form/ Consultation form for a nexus letter and/or DBQ:

To contact Dr. Finnerty for the first time about getting a nexus letter from him please fill out the form below to see if Dr. Finnerty can help with a nexus letter and/or DBQ. Filling out the form is the fastest and most reliable way to get Dr. Finnerty to see your information (faster than email and voicemail). Please note: If you need a nexus letter or an exam that does not involve a psychological condition please do not fill out the form as Dr. Finnerty is a psychologist and this is outside his area of expertise. You can find professionals for that here: For example, Dr. Finnerty will address questions where there is a psychological component such as whether sleep apnea was caused or substantially aggravated by a psychological condition, but Dr. Finnerty will not work on cases where the question is sleep apnea secondary to a physical condition like tinnitus, rhinitis, burn pits, etc.

Important: After you complete the referral form please pay attention to your spam folder. Dr. Finnerty’s responses sometimes end up in spam. The email may be coming from [email protected] or [email protected]

Dr. Finnerty wrote a book to help answer your questions on Sleep Apnea Secondary to PTSD. You can purchase it or read it for free with a free trial of Kindle Unlimited at Amazon. The book is Sleep Apnea secondary to PTSD: Nexus letters for Veterans’ VA disability claims.

Dr. Finnerty wrote the book on sleep apnea secondary to PTSD; he also writes nexus letters for it.

Are you interested in Dr. Finnerty’s opinions related to the VA’s 2022 proposed changes to the sleep apnea rating and/or the VA’s mental disorders rating schedule? You can watch him talk about his public comments on YouTube or read them with the links below:

…and in January 2024 did the VA make an unconstitutional rule change to how they evaluate insomnia disorder when they avoided the official rulemaking process? I have no idea (I’m not an attorney/accredited rep or government type). What I do know as a psychologist and expert on sleep is that… the VA’s guidance on Insomnia Disorder is WRONG.

Thank you

Here is Step 1 to get your nexus letter and/or DBQ from Dr. Finnerty.