What is a VA Disability Nexus Letter for PTSD?

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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:

  1. Current diagnosis of a disability,
  2. In-service event, disease or injury, and
  3. 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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How Can I Get TDIU?

How Can I Get TDIU?

Many veterans are unable to earn a living because of service-connected disabilities. Congress created a special benefit called TDIU to help these veterans live comfortably. Also known as Unemployability. TDIU pays the same monthly amount as a 100% disability rating.