Nexus Letter for PTSD

Mark D Worthen PsyD (Dr. Worthen), can provide a nexus letter for PTSD, and other mental disorders, in select cases. 

Dr. Worthen will provide a nexus opinion only after conducting an in-person comprehensive psychological evaluation.

I will provide a nexus opinion for PTSD if I believe a nexus letter will probably support a veteran's disability compensation claim

It's a three-step process. 

Step 1a - Complete the Nexus Letter Screening Questions (below) to make sure this is a good time for a Record Review. 

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) (conducted in Utah) will most likely support your claim, you can then retain me for such an evaluation.

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 $1495 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 $1300.

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 #1: Nexus Letter Screening Questions

These questions will help you determine if a Record Review by Dr. Worthen is a logical next step or not.

Write down the number next to your answer. For example if your answer to Question #1 is "Yes", you would write down "3". If your answer is "No", you would write down "0". 

Write the numbers in a column. You will add them up at the end.

1. Is the veteran represented by a Veterans Service Officer, VA-accredited Claims Agent, or a VA-accredited Attorney?
Yes (3) No (0) Not sure (0)


2. Has the veteran been diagnosed with posttraumatic stress disorder (PTSD)?
Yes (3) No (0) Not sure (0)


3. Do you have all the veteran's medical & psychological treatment records?

Yes (3) No (0) Not sure (0)


4. Do you have copies of previous mental health C&P exam reports (DBQs)? [if applicable]

Yes (3) No (0) Not sure (0) Not applicable (3)


5. At what stage is the veteran's PTSD claim?

(a) The veteran has NOT filed a disability compensation claim yet. (-3) (b) The veteran has filed a disability benefits claim with the Department of Veterans Affairs (VA), but he or she has not yet had a C&P exam for PTSD. (0) (c) The veteran has filed a disability claim with the VA and has had a C&P exam for PTSD. (2)


6. Have you received VBA's decision letter? (Telling you whether or not the veteran's PTSD is service connected, and if so, the disability rating (percentage).

Yes (2) No (0)


Add up the numbers in your column to arrive at a total score.

Here is an example:

Question Answer Points
Yes 3
2 Yes 3
3 Not sure 0
4 n/a 3
5 (c) 2
6 Yes 2
TOTAL - 13

Score Interpretation

Now interpret your Total Score according to the table below.

Score Interpretation
-3 to 5 Not ready for a Record Review
6–9 Maybe ready for a Record Review
10–11 Probably ready for a Record Review
12–16 Ready for a Record Review


Your Total Score and its Interpretation constitute an estimate for the value of moving forward with a Record Review. It is not cast in stone.

Record Review costs $195.

I don't want you to spend that much money if a Record Review won't help your claim at this point in time.


See also my educational website,, for info on C&P exams with U.S. military veterans. (No ads. No affiliate links. No sales pitches.)

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.

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