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Not every VA mental health claim needs a private nexus letter.

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A nexus letter provides evidence about how your current disability was caused by your military service in some way. Sometimes that link is already established, and sometimes it is the key missing piece of evidence for a claim.

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Which claims need a nexus letter?

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1. Claims that have been denied for lack of service connection.

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I often work with veterans who say "The VA examiner diagnosed me with depression but they still denied my claim." A diagnosis in itself does not establish that your diagnosis was caused by your military service. That is what the nexus does. When you hire a medical professional to write a nexus letter for you, they should take careful time to review your records for any possible evidence allowed under VA regulations that could support the link between your disability and your military service. This kind of time and attention is often not provided by VA C&P examiners, who rarely provide detailed reviews of complex documentation, or routinely deny claims based on lack of in-service documentation. A good nexus letter writer will understand how to work with your individual evidence to write a strong opinion in support of your claim. A GREAT nexus letter writer will be able to analyze the previous denial for deficiencies, and tailor their nexus letter to directly address the VA's reasons for denial. That is why I provide additional "rebuttal" services for claims that have been denied. 

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​2. A VA C&P examiner provided a negative medical opinion

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I often see claims where the VA examiner reached a negative conclusion for a variety of reasons. A great nexus letter can include a rebuttal of the previous examiner's reasons for denial. This is when it's important that your nexus professional has a deep knowledge of VA regulations, and experience with the VA's rules for what an adequate medical opinion requires. Unfortunately for veterans, VA C&P examiners often rush through their opinions and do not provide a thorough reason for why they don't think your disability was caused by your service. A good nexus letter can combat a negative opinion from a VA examiner.

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3. Secondary Claims

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A secondary claim is when a condition occurs because of a primary disability that is already service-connected. This can be a mental health condition like depression or anxiety that occurs because of a service-connected physical disability (like tinnitus or chronic pain), or a physical disability that occurs because of a service-connected mental health disability (like migraines or IBS caused by PTSD). The connections between mental health and physical conditions can be complex, and again, VA examiners often do not take the time or may not even have the deep expertise to provide competent opinions about complex claims. This is where an expert medical opinion can be crucial. A good nexus letter will examine your evidence and personal statements, thoroughly review medical literature regarding the relationship between your disorders, and make a logical argument as to why it is "at least as likely as not" that your service-connected disability has caused or aggravated your claimed disability. A good nexus letter will also include the type of opinion and language required by the VA in these types of medical opinions, which is consistently being updated based on case law. A nexus is often THE most crucial piece of evidence in secondary claims with the VA. 

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4. Mental health claims with weak objective evidence or lack of medical records.

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I often see mental health claims denied for lack of in-service treatment records for mental health. A wonderful quality about many veterans is that they are tough and resilient, and take responsibility for solving their own problems. This is so essential to being successful in the military. But it can become a problem when challenges arise that overwhelm a veteran's natural ability to cope. This is very common regarding health concerns, especially mental health, because military culture does not encourage seeking help or admitting weakness, especially about mental health issues. Most veterans therefore tough it out until their symptoms become overwhelming or have nearly ruined their life. Then when they are finally ready to seek help, it's too late to establish the paper trail the VA requires for disability claims. That is where a nexus letter can help. You'll need to make sure to have solid lay statements lined up from friends and family who have directly observed the changes in your behavior and emotional states before, during, and soon after your military service. You'll have to be able to provide a detailed personal statement regarding specific ways your mental health symptoms developed during your military service and why you avoided treatment. You may also need to reflect on your military service for any objective signs that would have indicated you were experiencing mental health symptoms that went unreported, like performance declines, disciplinary action, alcohol abuse treatment, etc. But a good nexus letter writer will understand how to take these pieces of evidence to create a strong nexus letter to support your claim. A nexus letter can be further strengthened by a direct examination by the nexus writer who can also fill out the VA's Disability Benefits Questionnaire (DBQ) form, so that no detail is left out of your VA claim. 

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Who DOESN'T need a nexus letter?

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1. You're already service-connected and are seeking an increase.

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A nexus letter provides the connection between your military service and your disability - if you are already service-connected and rated for a disability, then the VA has already established that the link exists. A nexus letter won't help you get an increase in your rating. What you need is an independent exam and DBQ that will document the current severity of your disability for rating purposes. 

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2. You already have a strong favorable medical opinion and strong objective evidence to support your claim.

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This is especially true for an initial claim - if you have strong evidence to begin with, a nexus letter may not be necessary. It's often best to try your initial claim to see if it is approved, and then follow up with a nexus letter in the event that your claim is denied. 

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3. The reason your claim was denied was not due to a lack of medical nexus. 

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Sometimes the problem with a claim has nothing to do with a medical opinion. 

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For example, VA might accept that PTSD is related to a particular traumatic event but determine that the evidence does not establish that the event occurred.  In that situation, another psychologist repeating the same nexus conclusion may not address the actual problem. A psychologist cannot establish that an event did or did not objectively occur; in these cases you'll need to find additional supporting evidence from buddy letters or records to establish the occurrence of the traumatic event or injury.

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Likewise, questions involving filing deadlines, choice of appeal lane, effective dates, procedural errors, or interpretation of veterans law are legal or claims-administration issues rather than psychological questions.

Those issues are generally better addressed by a VA-accredited VSO representative, claims agent, or attorney.

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Related Nexus Opinion Resources

 

Nexus Letter vs. DBQ vs. Independent Mental Health Evaluation: What Do I Actually Need?

Learn what each type of evidence addresses and when one may be more appropriate than another.

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Who Can Write a Mental Health Nexus Letter?

Learn how professional qualifications, specialty training, and the particular medical question affect who is qualified to provide an opinion.

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What Makes a Strong VA Mental Health Nexus Opinion?

Learn why record review, chronology, contradictory evidence, medical research, and individualized clinical reasoning matter.

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How to Choose a Psychologist for a VA Mental Health Nexus Letter

Learn what to look for when selecting an independent psychologist and what warning signs should make you cautious.

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About the Author

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This resource provides general educational information about psychological and medical evidence in VA disability claims. It is not legal advice. Questions involving claims strategy, appeals, deadlines, or interpretation of veterans law should be discussed with a VA-accredited representative, claims agent, or attorney.​

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