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.
Medical History
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.
What is a VA Disability Nexus Letter for PTSD? If you’re reading this, then you are probably familiar with the basics of a VA disability claim. Before we discuss what a medical nexus letter is lets review the basics. To win a VA disability claim, the veteran must prove all required elements of that specific claim. In general, VA will only grant your claim if you prove these 3 elements:
Current diagnosis of a disability,
In-service event, disease or injury, and
Medical nexus between the first 2 elements.
A veteran’s doctor can provide a current diagnosis. Either service records or witness statements can prove the in-service event. The medical nexus requirement is often the most challenging element to prove.
What is a VA Disability Medical Nexus Letter for PTSD?
A good medical nexus letter can be the difference between winning your PTSD claim and losing it. However, it is not enough for a doctor to state that the current diagnosis is related to the in-service event. Unless the letter meets certain requirements, VA will not accept it as evidence. A strong medical nexus letter should:
Be written by a qualified medical professional,
Be based on the veteran’s medical history both
during and after service,
Include an opinion on the likelihood that the
veteran’s disability was caused or aggravated by the in-service event, and
Include an explanation for the opinion that is
easy to understand.
VA Disability Nexus Letter for PTSD: Qualified medical professional
As the term suggests, only a medical professional can provide a medical nexus letter. This means that a veteran should only seek this from someone with the appropriate medical training. In limited circumstances, non-doctors such as physician’s assistants and nurse practitioners can write medical nexus letters. However, keep in mind that VA may get a competing nexus letter from someone more qualified than a nurse practitioner.
In all cases, a veteran should seek the most competent medical professional for this important task. For example, if you need a medical nexus letter for PTSD, then you should probably consult a mental health professional like a psychologist or psychiatrist. A PTSD nexus letter from an orthopedist probably would not help your case. Choose your author wisely, and make sure the letter includes his/her qualifications and contact information.
VA Disability Nexus Letter for PTSD: Medical history provides context
When it comes to what caused a disability, context is everything. If the medical professional doesn’t know the service and post-service medical history, then how can he tell what caused the disability? This requirement helps VA avoid paying veterans for disabilities unrelated to service. Let’s say a veteran is seeking a medical nexus letter for PTSD and PTSD. He tells his doctor that the PTSD must have been related to racial discrimination he suffered in service, and the PTSD followed soon after. However, his medical records show there was no PTSD diagnosis until he was involved in a fatal car accident 12 years after discharge. If the doctor writes a medical nexus letter without this context, then VA would probably reject it outright.
VA Disability Nexus Letter for PTSD: What if the doctor is not 100% sure?
While the burden is on the veteran to prove his claim, the standard of proof is much lower than in criminal or civil cases. A VA disability nexus letter for PTSD does not need to express 100% certainty. It does not even need to be beyond a reasonable doubt. If your doctor finds there is at least a 50/50 chance that your disability is related to service, then that is enough to win. In other words, a good medical nexus letter states that it is “at least as likely as not” that the disability is related to service. Of course, if your doctor believes it is more likely than not, then this only strengthens the nexus letter. The more context a veteran provides, the more certain a doctor can be of the relationship to service.
VA Disability Nexus Letter for PTSD: How did you get to your conclusion?
Most of the value of a medical nexus letter comes from its reasoning. If it only contains data and conclusions, then VA will reject it. A nexus letter that merely lists the evidence reviewed without explaining why it led to the conclusion has no value. At a minimum, the explanation must allow VA to conclude that the doctor applied valid medical analysis to the facts pf the case.
Example of a VA Disability Nexus Letter for PTSD
Let’s say you are seeking a medical nexus letter for PTSD. For the past 5 years, you’ve seen a psychiatrist for regular treatment. After the doctor agrees to help, you give him full access to your military and civilian medical records. During his review, the doctor notes that you had in-service medical treatment for symptoms of PTSD. The doctor also notes that the PTSD was diagnosed less than 2 years after service. After reviewing medical literature, the doctor agrees that “it is at least as likely as not that” your PTSD is related to your military service. His 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 his opinion. This would be a very strong medical nexus letter for PTSD.
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VA Permanent and Total Disability (TDIU) for PTSD. The VA will award Permanent and Total disability to veterans whose disabilities are Total (rated 100% disabling by VA) and Permanent (very low likelihood of improvement). Although the terms “Permanent” and “Total” are often discussed together, it is possible to have a permanent disability that is not totally disabling. For example, a veteran may have a permanent disability (such as PTSD) at 70%. Her PTSD is not “Total” because it is less than 100%. Likewise, it is possible to have a total disability that is not permanent. For example, the same veteran’s PTSD may be temporarily rated at 100% during hospitalization for a suicide attempt.
PTSD Rating Schedule for TDIU
Rather than assign percentages at random, VA uses a Schedule of Ratings. The Schedule of Ratings breaks down disabilities into different categories, which contain groups of medical problems, list of disabilities, and diagnostic code. Therefore, every diagnostic code specifies the symptoms required for various ratings. For example, the 9411 code applies to PTSD. VA rates PTSD –along with 36 other mental health conditions – under the General Rating Formula for Mental Disorders. Depending on the symptoms, a veteran may receive either 0%, 10%, 30%, 50%, 70% or 100%.
VA will award Permanent & Total Disability (TDIU) for PTSD
The veteran’s PTSD meets the criteria for a 100% rating, and
Medical evidence shows that the PTSD is not likely to improve during the veteran’s lifetime.
Total PTSD Rating
VA will award a total rating for PTSD if it causes total occupational and social impairment. Per the Schedule of Ratings, the following symptoms merit a 100% rating for PTSD:
gross impairment in thought processes or communication;
persistent delusions or hallucinations; grossly inappropriate behavior;
persistent danger of hurting self or others;
intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene);
disorientation to time or place; or
memory loss for names of close relatives, own occupation, or own name.
VA will only concede these symptoms if they appear in medical records. In other words, VA will not grant Permanent and Total Disability for PTSD based solely on the veteran’s statements.
VA 100% Rating, Permanent and Total Disability (TDIU) for PTSD
A 100% rating for PTSD satisfies the “Total” part of Permanent and Total Disability. Whether a 100% PTSD is “permanent” is a medical question for the veteran’s treating doctor. Will this condition ever improve during the veteran’s lifetime? If the doctor’s answer is no, then the veteran should submit the doctor’s written opinion to VA. VA will likely defer to the medical opinion and award Permanent and Total disability for PTSD.
Case Study 1: Permanent and Total Disability (TDIU) for PTSD
A 40 year-old Gulf War combat veteran filed a claim for PTSD in 2011. In 2012, VA denied the claim despite the Combat Action Ribbon noted on his DD Form 214. After significant development, DHG representatives won the case on appeal. The medical evidence proved that he met the criteria for a 100% rating. His symptoms included unprovoked irritability with periods of violence, impaired impulse control, and audio hallucinations. They were so severe that he could not hold a job. In addition, his doctor wrote that his symptoms would only get worse throughout his lifetime. Consequently, VA awarded a Permanent and Total disability for PTSD.
Case Study: Permanent and Total Disability (TDIU) for PTSD
A 45 year-old Peacetime veteran received a 70% rating for his PTSD. After service, he worked in a Ford Motor Company manufacturing plant for 15 years. After a workplace injury to his back, he was medically retired. A VA medical exam found that his PTSD was unlikely to improve. However, there was no medical evidence to support a 100% rating. But for his workplace accident, he would be able to work. VA decided to keep his rating at 70%, which is less than total. Consequently, he was not entitled to Permanent and Total disability for PTSD.
Case Study: Permanent and Total Disability (TDIU) for PTSD
A 22 year-old Air Force veteran witnessed a deadly parachute accident. It happened 3 months into his active duty service. As a result, he was diagnosed with PTSD and anxiety disorder. Unfortunately, he turned to drugs and alcohol to self-medicate his symptoms. Within 2 years of his discharge, he was homeless. When he filed a PTSD claim, VA denied it for insufficient evidence. At the local VA hospital, he met another veteran who referred him to DHG. DHG then developed medical evidence, a lay statement from the veteran, and legal arguments. In response, VA scheduled a PTSD medical examination. VA’s own examiner recommended a permanent 100% rating. Shortly afterwards, VA awarded a Permanent and Total disability rating for PTSD.
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