Nexus Letter for PTSD

Nexus letter - Mark D Worthen PsyD (Dr. Worthen), can provide an expert opinion regarding service connection for PTSD, and other mental disorders, in select cases. 

I specialize in appeals cases. In other words, I conduct independent psychological evaluations of veterans:

  1. appealing a denial of an original claim;

  2. appealing a denial for a requested rating increase;

  3. challenging a VA proposal to reduce a veteran's service-connected disability rating.

Important Considerations

Please understand:

  • I will provide a nexus opinion only after conducting a comprehensive psychological evaluation.

  • I can conduct a Tele-C&P exam via secure video, but only if you live in a PSYPACT state.

  • I charge $2000 for the evaluation and report.

  • In most instances I conduct evaluations only if requested by a veteran's attorney, i.e., the veteran's attorney retains me and pays the $2000 fee. (The same is true for VA-accredited claims agents.)
  • Communications between an attorney and a retained expert fall under attorney-client privilege, which is stronger protection for the veteran compared to veterans representing themselves. (Stronger protection with regard to a veteran's privacy and confidentiality.)

Do You Need a Nexus Letter?

Although many people say you should obtain a nexus letter before you file an original (initial) claim for VA disability benefits, I disagree. Here's why:

* A majority of veterans have a positive experience with the VA medical examiner who conducts their C&P exam, and their claim is granted (approved) by the Veterans Benefits Administration (VBA). 

In other words, most veterans do not need a nexus letter for an original (initial) claim. Naturally, there are some exceptions to this rule.

  • Exception #1: If you are represented by a veterans service officer and they recommend a nexus letter, I am more likely to agree. In those instances I would want to communicate with you and your veterans service officer to understand the reason(s) for a nexus letter. Veterans service officers usually recommend a nexus letter (independent exam) for more complicated situations, e.g., MST-related claims (MST = Military Sexual Trauma).

  • Exception #2: You filed a claim, had your C&P exam, and you learned that the examiner gave VBA an unfavorable opinion. It might make sense to prepare for an appeal since the VBA decision will likely be unfavorable.

  • Exception #3: You filed a claim, had your C&P exam—but the exam was awful, then it might make sense to get ready to appeal the VBA decision (assuming it will be unfavorable).

Note that you can also request another C&P exam. The Veterans Benefits subreddit on has an excellent Knowledgebase, including articles like What to do if you had a bad examiner.

Veterans Service Officers - You Should Have One

Here's what VA says about Veterans Service Officers:

If you need help filing a claim or appeal, you may want to work with a Veterans Service Officer (VSO). We trust these professionals because they’re trained and certified in the VA claims and appeals processes and can help you with VA-related needs. VSOs work on behalf of Veterans and service members—as well as their dependents and survivors.

Request a Nexus Letter: 3 Steps

Step 1a - Ask yourself (and trusted others) if you really need a nexus letter. 

Step 1b - If you probably want to proceed with a Record Review, but you have some questions you would like to ask first, complete the form on the Forensic Evaluation Inquiry page. We will subsequently communicate via encrypted email.

Step 2 - Record Review: Submit military and medical records to Dr. Worthen for review. This is a professional psychological service for which I charge a flat fee of $195.

Step 3 - Independent Psychological Exam: If after reviewing your records I believe an Independent Psychological Exam (IPE) will most likely support your claim—and if you live in a PSYPACT state—you can then retain me to conduct an evaluation using secure video conferencing software. VA calls such exams "telemental health examinations" or "Tele-C&P exams".

After conducting the exam, I will:

  • write an exam report;

  • complete the PTSD DBQ; and

  • send you the exam report and DBQ via secure email or USPS Priority Mail.

I charge a flat rate of $1995 for Independent Psychological Exams for VA disability claims. Since you will have paid $195 for the Record Review, if we both decide to proceed to an IPE after I review your records, your amount due will be $1800.

This is a "retainer fee" that I will refund before the IPE if you give me 48 hours (or more) notice prior to the day and time of the scheduled IPE. After I conduct the exam, the fee is not refundable.

Step #2: Record Review

Please talk with your Veterans Service Officer, VA-accredited Claims Agent, or Veterans Law Attorney, and ask for their advice before requesting a Record Review.

If you and your representative believe you are ready for a Record Review by Dr. Worthen:

(a) Upload your records using a secure form;

(b) Go to the payment page to send Dr. Worthen the $195 Record Review fee.

What If I Don't Want a Representative?

I understand that some veterans and family members prefer to handle their disability claims themselves, without a representative.

You certainly have that right, and I have known several veterans and family members who have studied VA disability claims laws, regulations, policies, and procedures, and do an excellent job representing themselves.

However, representing yourself requires a lot of study and preparation.

Specifically, you will need to devote at least 50 hours to reading, asking questions,  searching the Internet, and consulting reference librarians for information.

If you have done your homework, and you choose to represent yourself, I will respect your autonomy and work with you.

However, if you start to ask me questions that any Veterans Service Officer would know the answer to, then I will stop and insist that you retain a Service Officer, Claims Agent, or Veterans Law Attorney.

That might sound harsh, but I want you to have competent, effective representation.

What Do You Think?

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