VA Nexus Letter for PTSD. VA will pay disability compensation to a veteran if he proves his disability is related to military service. As part of the process, VA uses disability nexus letters to figure out whether a disability was caused or aggravated during service. If the answer is “No”, then VA will not pay for that disability.
Will You Need a VA Medical Nexus Letter for PTSD?
Not every VA claim needs a nexus letter because in some cases, the link to service is undeniable. For example, if your service records include a diagnosed disability you still suffer from today, then VA would probably grant a claim for that disability without a nexus letter. In claims for certain chronic conditions, VA will concede a relationship to service if there is a diagnosis within 1 year of discharge.
However, what if you don’t have a diagnosis until many years after service? For example, Vietnam veterans with Agent Orange exposure usually don’t develop herbicide-related disabilities (such as diabetes mellitus type II) for several years. The gap from discharge to diagnosis can be even greater with mental health disorders. Many veterans respond to traumatic in-service events by trying to cope on their own. Coping mechanisms include self-medication with drugs or alcohol, avoidance of medical treatment, and withdrawal from social situations. When the symptoms get much worse and they finally seek mental health treatment, a doctor renders a diagnosis of PTSD. To win this kind of claim, a strong disability nexus letter for PTSD is essential.
Who should Write Your VA Nexus Letter for PTSD?
Only a medical professional with the appropriate medical training should write a disability nexus letter. In limited circumstances, non-doctors such as physician’s assistants and nurse practitioners can write them. However, VA will find a disability nexus letter more persuasive if written by a doctor in the relevant specialty. For mental health disorders such as PTSD, a psychologist or psychiatrist would be ideal.
From time to time, VA will ask affiliated doctors to write disability nexus letters. However, most of those are not favorable to the veteran. Give yourself the best chance to win by seeking an independent disability nexus letter. If applicable, you should have your treating doctor write one. That doctor is probably more knowledgeable about your condition than any of VA’s hired guns.
Requirements for a VA Nexus Letter for PTSD
VA will only accept a disability nexus letter if it meets certain requirements. A strong disability nexus letter for PTSD must include:
- A discussion of relevant medical history from service to the present day,
- The likelihood that the PTSD was caused or aggravated during service, and
- A reasoned explanation for the conclusion.
The medical history from service to the present day is especially relevant to what caused PTSD. Even the PTSD diagnosis happens years after service, the onset of the disability can be shown in service records. Let’s say a veteran claims that racial harassment during service caused a persistent PTSD disability. The service medical records don’t show treatment for PTSD. However, the personnel records showed a drastic change in behavior 5 months prior to discharge. His first 5 years of service included multiple commendations for performance. In the last 5 months, he received multiple Article 15 punishments. A good disability nexus letter would consider whether the sudden behavioral change marked the onset of PTSD.
How likely is PTSD related to service?
The burden is on the veteran to prove his claim. However, the standard of proof is much lower than in a criminal case. The doctor who writes the nexus letter does not have to be 100% sure of the link. Because this is a veteran-friendly system, VA requires at least 50% certainty. If your doctor finds there is at least a 50/50 chance that your PTSD is related to service, then that is enough to win. In other words, a good disability nexus letter states that it is “at least as likely as not” that the disability is related to service. A strong nexus letter would express “more likely than not” certainty.
A doctor is more likely to write a good disability nexus letter if PTSD clearly existed from service to the present day. You can improve your odds by giving your doctor any of the following:
- Your full service medical and personnel records,
- Lay statements from friends and family who observed your behavior from service to the present day, or
- Post-service medical and/or arrest records relevant to PTSD.
What is the doctor’s reasoning?
In a disability nexus letter for PTSD, 80% of the value comes from the doctor’s reasoning. If the letter only contains data and conclusions, then it won’t help the case. At a minimum, the reasoning must be clear, concise and supported by valid medical analysis.
For example, let’s say you are seeking a medical nexus letter for PTSD. After reviewing your medical history, your psychologist agrees that “it is at least as likely as not that” your PTSD was incurred during your military service. Her medical nexus letter should explain why the in-service symptoms and the post-service diagnosis matters. It should also cite any medical literature that supports her opinion. If there was any post-service trauma, she should explain how it only made the existing PTSD worse.
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