FAQ

Disability Benefits Questionnaire (DBQ): $500

Nexus Letter (up to two conditions): $300 

TDIU (Unemployability) Letter: $300

Letter in support of Homebound Status: $300

Payment is due on the day of the appointment, prior to the start of the appointment. Prices are as noted. There are no additional fees or charges. Payment is made in the HIPAA compliant portal.

Private DBQ and nexus letter completion is generally not covered by any insurance. The Racho Group accepts cash, debit and credit card payments.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. You will receive a Good Faith Estimate for the total expected cost of any scheduled services.

A Disability Benefits Questionnaire (DBQ) is a templated questionnaire used by clinicians in a variety of fields, to evaluate for the presence of a disorder. There are over 70 types of DBQs ranging from those that evaluate for and ask about musculoskeletal or neurological problems, to those used for mental health. There are three specific types of DBQs used to evaluate for mental health disorders. The Initial PTSD DBQ is used when evaluating specifically for a diagnosis of PTSD. The Mental Disorders DBQ is used when evaluating for any mental health disorder other than PTSD or an eating disorder  – such as anxiety, depression, bipolar, or insomnia. The Eating Disorders DBQ is used when evaluating for an eating disorder.

The completion of a mental health DBQ allows the clinician to make any necessary diagnoses and to describe how the symptoms of the diagnosed disorder/s are impacting functioning. In other words, its allows the clinician to explain to the VA how the symptoms you are experiencing are negatively impacting the quality of your relationships, work performance, education, and engagement in friendships, hobbies, interests, and life. The level of impact described in the DBQ helps the VA assign an accurate rating percentage for the disorder diagnosed, when service connection is granted. 

For VA purposes, a nexus letter, or medical opinion, is a conclusion statement written by a qualified examiner, using medico-legal language, summarizing their opinion about the case, based on current medical knowledge and all available evidence. There are three different types of medical opinions – direct, secondary, and aggravated.

A direct medical opinion states that the Veteran’s current condition was caused by, began during, or is otherwise directly related to military service.

Example:

• A Veteran experienced a traumatic event during deployment and now meets criteria for PTSD.
• A psychologist opines that the PTSD is “at least as likely as not” caused by the in-service stressor with supporting evidence.

A secondary medical opinion states that a service-connected condition caused another condition.

Example:

• A Veteran is service-connected for chronic back pain.
• The chronic pain leads to depression.
• A psychologist opines that the depression is “at least as likely as not” secondary to the service-connected back condition.

An aggravation opinion states that a service-connected condition did not necessarily cause the new condition, but permanently worsened it beyond its natural progression.

Example:

• A Veteran had mild anxiety before service or before developing chronic migraines.
• The service-connected migraines significantly worsen the anxiety.
• The psychologist opines that the anxiety has been aggravated beyond its natural progression by the migraines.

All nexus letters/medical opinions must be accompanied by a well-supported rational

Because examiners use clinical judgement, experience, and knowledge to evaluate for a disorder and write a nexus letter, it is possible for different opinions to be formed, based on a review of the same evidence/case. 

You may call, email, or send a message through our website with any questions. or to schedule your DBQ completion.

Once an appointment time is confirmed, you will receive a link to establish a portal account. This is where you will sign consent forms, make payment, join the appointment, and access the DBQ and or nexus letter later that day. 

Any documents you would like use to review can be easily uploaded into the HIPAA compliant portal.

We see patients, Service Members and Veterans throughout the week, by appointment only.

Although days and hours vary, we make it a priority to schedule appointments within 1 week of you reaching out, and  guarantee we will have all documentation to you within 48 hours of the appointment, though usually you will have them later the same day.

As a licensed psychologist, I cannot diagnose any medical disorder. However, research has shown that certain physical disorders very often develope as a result of certain mental health disorders, and the impact of certain mental health symptoms on the body. In these instances, if you are already diagnosed with the medical condition, I can provide a DBQ for mental health and a nexus letter outining the research that supports the link between the physical and mental disorder.

Examples include:

• Sleep apnea secondary to PTSD, anxiety or depressive disorders
• Gastrointestinal disorders (GERD, IBS) secondary to PTSD, anxiety or depressive disorders
• Hypertension secondary to PTSD, anxiety or depressive disorders
• Migraines secondary to PTSD, anxiety or depressive disorders
• Obesity secondary to PTSD, anxiety or depressive disorders
• Type II Diabetes secondary to PTSD, anxiety or depressive disorders
• Erecticle dysfuntion secondary to PTSD, anxiety or depressive disorders

Being denied service connection can feel discouraging, especially when you know your condition began during service or has been significantly impacted by a service-connected disability. Many Veterans leave the process feeling unheard, frustrated, or unsure of what evidence may have been missing from their claim.

A private DBQ and Nexus Letter can provide an opportunity to have your story fully heard and carefully documented. During a comprehensive evaluation, your symptoms, military history, medical records, and functional impairments are reviewed in detail. The resulting DBQ helps clearly communicate the severity and impact of your condition in a format familiar to VA decision-makers.

While no provider can guarantee an outcome, a well-supported private evaluation can help clarify important evidence, address gaps identified in a prior denial, and ensure that your experiences and symptoms are accurately represented. For many Veterans, it provides confidence that their claim is being supported by a detailed, independent medical opinion grounded in both clinical expertise and VA standards.

The DBQ completion will take up to but no more than one hour. DBQs competed for an increase usually take 30 minutes. The completed DBQ and Nexus (and or Unemployability letter) are guaranteed to be accessible to you within 48 hours of the appointment, but most often later the same day.

Yes! The VA must consider competent private medical evidence submitted by qualified healthcare providers. As a licensed psychologist with over 7 years of experience completing VA-assigned C&P mental health examinations, I have extensive familiarity with the exact standards, language, and criteria the VA uses when evaluating disability claims.

A private DBQ can be especially helpful when a Veteran has been previously denied service connection or received an unfavorable C&P exam, as it provides an additional, independent clinical perspective based on a comprehensive evaluation.

All evaluations are conducted in a Veteran-centered, respectful manner and are available via telehealth in Colorado and most PSYPACT-participating states.

A Compensation & Pension Exam (C&P exam) is an evaluation ordered and paid for by the VA, and conducted by a VA clinician or VA-contracted examiner.

An independent DBQ evaluation is a similar evaluation,  conducted by a clinician of the Veteran’s choosing, and paid for by the Veteran.

Ideally, both examinations will make all necessary and appropriate diagnoses based on clinical interview, record review, and professional judgment, and describe the impact current mental health symptoms are having on relationships, work and educational performance, and the ability to engage hobbies, interest, and activities.

Although similar, there are important differences between a VA C&P exam and a private DBQ completion/evaluation.

A VA-assigned examiner is often asked to evaluate only the specific condition you claimed and answer only the questions the VA has requested. In contrast, a private examiner conducts a comprehensive evaluation and can diagnose any mental health condition that meets the appropriate diagnostic criteria, even if it was not originally claimed.

Very often, what ends up being diagnosed in a C&P exam is not what was originally claimed.

For example, many Veterans file a claim for insomnia because they have severe sleep problems. However, sleep problems are a common symptom of several mental health conditions, such as PTSD, depression, or an anxiety disorder.

If the examiner determines that an anxiety disorder is the cause of the sleep problems, no diagnosis of insomnia will be made. In this case, if the VA only asks the examiner whether the Veteran has insomnia disorder related to military service, the examiner will answer negatively, because insomnia disorder as not diagnosed.  The VA may then deny the claim because there was no diagnosis of insomnia disorder—even though the examiner identified and diagnosed an anxiety disorder as the cause of the Veteran’s symptoms.

This is one of the most common reasons claims are denied despite a Veteran having a legitimate service-related mental health condition and symptoms. The issue isn’t necessarily that the Veteran doesn’t have a disability—it may simply be that the disability is different from what was originally claimed, and the examiner was not asked to provide an opinion on that diagnosis.

In contrast, a comprehensive private evaluation from The Racho Group will identify any and all diagnoses, as well as explain how they are related to military service, and provide the medical opinions needed to support the appropriate claim. This can help ensure that the Veteran’s symptoms are evaluated in the proper context rather than being limited to the wording of the original claim.

During a VA-assigned exam, the examiner cannot discuss the results of your evaluation with you. This means they cannot tell you what diagnoses were made (or not made), whether they believe your condition is related to your military service, or how they completed the medical opinion. In contrast, during a private evaluation, our clinician can and do share which diagnoses are made and why, and which aren’t, and why.  

Because the VA ordered the exam, they essentially “own” the information. You can usually access the report at a later date, after a record request made to the VA. 

During a private evaluation with The Racho Group, we believe you deserve to understand your own evaluation. Before your appointment ends, your clinician will explain the diagnoses that were made, why those diagnoses fit your symptoms, why other diagnoses may not apply, and whether your condition appears to be connected to your military service. You’ll have the opportunity to ask questions so you leave with a clear understanding of your evaluation—not left wondering what was written in your report.

Who can complete a private DBQ/independent evaluation?

While VA DBQs are publicly available and can technically be completed by any healthcare provider, the VA has identified specific types of mental health professionals who are qualified to perform mental health Compensation C&P examinations and complete these forms.

However, professional credentials alone do not necessarily mean a clinician has experience with VA disability evaluations. Mental health providers receive extensive training in diagnosing and treating psychological conditions, but most are not trained in the unique legal and medical requirements of VA disability claims, including how to complete DBQs and write medical opinions that address the specific questions the VA must answer.

When choosing a private evaluator, it is important to work with a clinician who not only has the appropriate credentials, but also has substantial experience with VA disability evaluations, understands VA regulations and evidentiary standards, and knows how to provide clear, well-supported medical opinions.

At The Racho Group, all mental health DBQs, Nexus Letters, and Independent Medical Opinions are completed by a licensed doctoral-level psychologist with seven years of experience performing VA-contracted C&P mental health examinations. That experience provides a thorough understanding of the VA’s evaluation process and the documentation needed to produce high-quality, evidence-based reports.

The Racho Group provides private Veteran disability evaluations both in person and by secure telehealth. In-person appointments are available in Colorado Springs, Colorado, and telehealth services are available to Veterans located in all current PSYPACT participating states. Visit our States We Serve page found under the Veteran Mental Health Disability Services tab to see if your state is eligible.