Nexus Letters for VA Claims

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

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I will proffer an expert opinion about the nexus between a veteran's military service and his or her current psychiatric disorder only after conducting a thorough psychological evaluation.

I can conduct the evaluation in-person in Charlotte, North Carolina or via telehealth if you live in a PSYPACT® state.

I use the term "nexus letter" to mean a psychological evaluation report and DBQ that includes my expert opinion about the connection between a veteran's military service and his or her current mental disorder, or between a current service-connected medical condition and a mental disorder.1 

I will review relevant records first, for a $540 retainer fee that pays for two hours of my time ($270/hour) reviewing records, and then let you know if I think an independent psychological exam (IPE) might support your claim. I will not write a nexus letter based on a record review alone.

If we both agree to proceed with an independent psychological examination (IPE), the initial cost is a $2700 retainer fee, which pays for 10 hours of my professional services. If the evaluation and all the involved tasks, including a DBQ and narrative report, will exceed 10 hours, I will notify you in advance and request another retainer fee to cover the additional time required. But I work hard to complete the evaluation in 10 hours.2

Thus, the total cost for an IPE is usually $3240 ($2700 + $540 you paid for the record review). If you decide to cancel the exam, the remaining balance will be returned to you. 

If I conduct an IPE, I will complete the relevant Disability Benefits Questionnaire (DBQ)* and write a psychological evaluation report. I can conduct independent psychological exams via secure video but only if you live in a PSYPACT® state and only if a telehealth exam is appropriate.

→ Be sure to read: Do You Need a Nexus Letter?

*Except for original (initial) PTSD claims, for which VA prohibits independent examiners from completing the Initial PTSD DBQ, but in that case Dr. Worthen will provide all the information required by the Initial PTSD DBQ in the narrative report with specific reference to each DBQ item, using the same section numbers as appear on the DBQ for easy cross-reference. For more information, see Should a Private Examiner Complete an Initial PTSD DBQ?

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Another Good Psychologist

I recognize that my rates are higher than most. If they are not feasible for you, there are other good, experienced psychologists who conduct independent psychological exams with veterans. Here is one:

Dr. Alexis Zornitta, Ph.D.
Virginia Licensed Clinical Psychologist
Advanced Trauma Recovery & Mental Healthcare, LLC
https://atrmh.com/veterans-disability-evalulations/
Phone: (757) 335-6485

Dr. Zornitta conducted C&P exams as a VA psychologist so she has a lot of experience in the area and does a thorough, conscientious, and accurate evaluation. Obviously, I cannot guarantee that you will be satisfied by the services Dr. Zornitta provides.

Important Considerations

Please understand:

  • I provide nexus letters for VA claims only after conducting a comprehensive independent evaluation.

  • I perform objective, unbiased exams. I am not on your side. I am not on VA's side. I am an independent examiner. 

  • I believe I have credibility because of this objectivity and independence. I am not just trying to make money writing unrealistically favorable exam reports.

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

  • Most veterans filing an original (initial) claim for PTSD or other mental disorders do not need a nexus letter.

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What is a Nexus?

A nexus is "a connection or link between things."3 

Nexus = Connection

Sometimes it is a causal connection. Post-Traumatic Stress Disorder (PTSD) is the best example of a causal connection. Traumatic events during military service often cause PTSD.

But the connection does not have to be causal. If a disease or injury was “incurred coincident with service in the Armed Forces,” that disease or injury is "service connected" (if it causes functional impairment).4  

Thus, nexus letters for VA claims can help in select cases if your mental disorder was caused by military service, developed during your military service, or was aggravated by military service.

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What does "incurred coincident with service" mean?

Incur is an important word in veterans law, but it is a unfamiliar word.

Incur means "to run or fall into (some consequence, usually undesirable or injurious)."5

Synonyms for incur include acquire and contract, like, "I acquired this rash when deployed to jungles in Central America" or "I contracted the flu at my kid's daycare."

So, a nexus is a connection between military service and a disease or injury. It might be a causal connection, but it does not have to be.

For example, if you developed clinical depression during military service, you do not have to prove that military service caused the depression. You simply need to prove that your depression began during military service.

Or, in the language VA uses, if your depressive disorder was incurred coincident (at the same time as) your military service, then it is (or should be) a service-connected condition (provided it causes functional impairment). 

In addition, if you had a depressive disorder before enlisting, and military service aggravated your depression (made it worse), then your depressive illness is (or should be) considered a service-connected disorder (provided it causes functional impairment).6 

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After you have read this entire page, if you want me to review your records, please schedule an initial brief consultation to discuss your case. 

Remember that I cannot write a nexus letter based on a record review alone.

The purpose of the record review is for me to analyze your records to determine if a comprehensive psychological evaluation might help your claim.

I do not want you to spend thousands of dollars for a psychological evaluation if the odds are low that the evaluation will help.

If you have questions, contact me. (Please read this entire page before contacting me.)

→ Be sure to read: Do You Need a Nexus Letter?

Nexus Letters for VA Claims: Definition of Terms

"The beginning of wisdom is the definition of terms." - Socrates†

In this context, medical opinion, nexus statement, and expert witness opinion mean the same thing.

A nexus is "a connection or link between things, persons, or events."7 

A nexus statement is an expert's opinion about connection, i.e., service connection. (The Veterans Benefits Administration makes the decision about service connection).

Here is an example of a nexus statement:

"It is more likely than not that the veteran's major depressive disorder is proximately due to or the result of her Parkinson's disease."

A nexus letter for VA claims contains one or more nexus statements. 

I use the term, nexus letter to mean a carefully completed DBQ* and a detailed narrative report, both based on an evidence-based, comprehensive psychological evaluation.8 

I use the term expert witness because, as the U.S. Court of Appeals for Veterans Claims explained: "Both VA medical examiners and private physicians offering medical opinions in veterans benefits cases are nothing more or less than expert witnesses."9 

VA uses the term medical opinion, whether or not the examiner has a medical degree, e.g., psychologists conduct most C&P exams for PTSD and other mental disorders, but our expert witness opinions are called medical opinions by VA even though we have a Doctor of Psychology (PsyD) or Doctor of Philosophy (PhD) degree.

---

†Although people usually attribute this aphorism to Socrates, he likely did not say it, at least not in this way.

*Except for original (initial) PTSD claims, for which VA prohibits independent examiners from completing the Initial PTSD DBQ, but in that case Dr. Worthen will provide all the information required by the Initial PTSD DBQ in the narrative report with specific reference to each DBQ item, using the same section numbers as appear on the DBQ for easy cross-reference. For more information, see Should a Private Examiner Complete an Initial PTSD DBQ?

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Request a Record Review

If you are a veteran seeking nexus letters for VA claims, please talk with your Veterans Service Officer, VA-accredited Claims Agent, or Veterans Law Attorney, and ask for their advice.

If you believe you are ready for a Record Review by Dr. Worthen, please schedule an initial brief consultation to discuss your case. 

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A-10 Thunderbolt "Warthog"A-10 Thunderbolt "Warthog"

Do You Need a Nexus Letter?

Many people say you should obtain nexus letters for VA claims before you file an original (initial) claim for VA disability benefits. But I doubt it's worth the money to pay someone for a nexus letter when you don't have to pay anything for the VA claim exam and the odds of winning your claim exceed 70%.10

Most vets don't need a nexus letter, but most vets do need a Veterans Service Officer.

Veterans Service Officers

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.

Search for a Recognized Veterans Service Organization (VSO) by state, city, or zip code on the VA's eBenefits website.

Also ask other veterans if they know of a good Veterans Service Officer. 

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After you have read this entire page, if you want me to review your records, please schedule an initial brief consultation to discuss your case. 

Remember that I cannot write a nexus letter based on a record review alone.

The purpose of the record review is for me to analyze your records to determine if a comprehensive psychological evaluation might help your claim.

I do not want you to spend thousands of dollars for a psychological evaluation if the odds are low that the evaluation will help.

If you have questions, contact me. (Please read this entire page before contacting me.)

→ Be sure to read: Do You Need a Nexus Letter?

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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Definition of "nexus"Screenshot from OED Online - the famous Oxford English Dictionary

After you have read this entire page, if you want me to review your records, please schedule an initial brief consultation to discuss your case. 

Remember that I cannot write a nexus letter based on a record review alone.

The purpose of the record review is for me to analyze your records to determine if a comprehensive psychological evaluation might help your claim.

I do not want you to spend thousands of dollars for a psychological evaluation if the odds are low that the evaluation will help.

If you have questions, contact me. (Please read this entire page before contacting me.)

→ Be sure to read: Do You Need a Nexus Letter?

Footnotes

1. Although less common, I also evaluate veterans for aggravation of a pre-existing mental disorder (38 C.F.R. § 3.306).

2. You might wonder why I devote 10–15 hours to an Independent Psychological Exam (IPE), especially when some psychologists conduct six or more C&P exams per day, completing the DBQ while talking with the veteran. There are some relatively simple exams, e.g., a "review exam" (request for increase) in which a psychologist can conduct an adequate evaluation in 60–90 minutes. But that is the exception, not the rule. 

According to VA:

"A C&P examination for PTSD is particularly complex because an examiner must ... comprehensively diagnose all comorbid mental disorders and apportion disability to various disorders in veterans who increasingly have co-occurring mental disorders; and render an informed opinion about the effects of PTSD on social and occupational functioning, requiring a careful and often time-consuming review of a veteran's history (emphasis added)."

Reference: Stressor Determinations for Posttraumatic Stress Disorder, 75 Fed. Reg. 39843, 39847 (July 13, 2010).

Many of the fast, cursory exams end up being favorable for the veteran. However, I doubt most such exams are truly evidence-based evaluations that would stand up to peer review, but frankly VA does not have high standards for C&P exams.

Thus, if a subpar exam is favorable to the veteran, it is not the veteran's problem that VA does not place much emphasis on exam quality.

This is one reason I recommend that you get a VA C&P exam first before paying someone like me four thousand dollars for a comprehensive evaluation.

If you get a VA C&P exam first and it goes your way, great. You will not only receive VA disability compensation and other benefits, you will have also saved yourself a lot of money for an unnecessary independent exam.

That said, I do conduct IPEs directly for veterans in some cases. For example, if VA (unjustly) denied a previous claim because of a bad exam or faulty analysis, or if your claim is uncommon or complex, then an IPE (independent psychological exam) might be worth it.

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3. Merriam-Webster.com Legal Dictionary, s.v. “nexus,” September 2023.

4. Principles relating to service connection, 38 C.F.R. § 3.303.

5. Oxford English Dictionary, s.v. “incur, v.”, July 2023.

6. Aggravation of preservice disability, 38 C.F.R. § 3.306.

7. Merriam-Webster.com Legal Dictionary, s.v. “nexus,” September 2023.

8. The term nexus letter sometimes suggests that a healthcare professional can simply review a veteran's records and chat with the vet briefly and then write a letter providing an expert opinion. For psychological claims (PTSD and other mental disorders), providing an expert opinion based on such a cursory review would probably violate ethical principles and professional standards of practice.

9. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008).

10. The "odds of winning your claim exceed 70%" if you have a Veterans Service Officer who has helped you (or you have done your research and really know what you're doing), and if you have solid evidence to support your claim. Seventy percent is an estimate based on my experience.

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