Nexus Letters for Mental Disorders

Mark D Worthen PsyD (Dr. Worthen) provides nexus letters for mental disorders if he believes a nexus opinion will probably support a veteran's disability claim. 

3-Step Process

How do I know if a nexus opinion will probably support a veteran's disability benefits claim?

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

It's a three-step process. 

Step 1 - Screening Questions: The veteran or his/her representative answer some basic questions to determine if it's worth moving on to Step 2.

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, you can then retain me for such an evaluation.

After conducting the exam in-person or via video teleconference, I will:

  • write an exam report;
  • complete the Mental Disorders DBQ (VA Form 21-0960P-2); 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.

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 a mental disorder?
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 Mental Disorder 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 a mental disorder. (0) (c) The veteran has filed a disability claim with the VA and has had a C&P exam for a mental disorder. (2)


6. Have you received VBA's decision letter? (Telling you whether or not the veteran's mental disorder 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.


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) 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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