PTSD Nexus Letters
A board-certified physician reviews your records and writes an individualized medical opinion letter connecting your PTSD to service. $400 flat rate.
Start My Nexus Letter$50 record review — applied toward your $400 letter.
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PTSD claims have unique evidentiary requirements. The right approach depends on your stressor type, service history, and available documentation.
Direct Service Connection
PTSD requires a current diagnosis meeting DSM-5 criteria, a verified in-service stressor event, and a medical opinion linking the two. Stressor events include combat exposure, military sexual trauma (MST), training accidents, vehicle crashes, witnessing death or serious injury, and other traumatic experiences during active duty.
Combat Veterans — 38 USC §1154(b)
If you served in combat, your lay testimony is accepted as sufficient proof that a stressor event occurred, as long as it is consistent with the circumstances of your combat service. You do not need official documentation of the specific event. Awards such as a CIB, CAR, CAB, or Purple Heart help establish combat status.
Stressor Verification
For non-combat stressors, the VA requires corroborating evidence that the event occurred. This can include buddy statements from fellow service members, unit records, incident reports, medals or commendations, deployment orders, or any official documentation that places you at the time and location of the claimed event.
C&P Exam Considerations
The VA will likely schedule a Compensation and Pension exam with a psychologist or psychiatrist. The examiner will assess whether you meet DSM-5 criteria for PTSD and whether your symptoms are linked to service. A strong nexus letter submitted before the exam gives the examiner a detailed medical opinion to consider alongside their own findings.
The stronger your supporting evidence, the stronger the medical opinion we can write. Here is what we look for in your records.
- ✓A formal PTSD diagnosis from a psychiatrist or psychologist confirming you meet DSM-5 criteria (Criterion A through Criterion H). A clinical evaluation with a structured diagnostic assessment carries the most weight.
- ✓A documented in-service stressor event. This could be combat exposure, military sexual trauma, a training accident, vehicle crash, witnessing death or serious injury, or another traumatic experience during active duty.
- ✓Buddy statements from fellow service members who witnessed the stressor event or observed behavioral changes after it occurred. These are especially important for non-combat stressors where official records may be limited.
- ✓Treatment records showing continuity of mental health symptoms from service to the present. This includes VA mental health records, private therapy notes, medication prescriptions, or emergency department visits related to psychiatric symptoms.
- ✓Medical literature connecting your specific stressor type to the development of PTSD. We provide this in the letter, citing peer-reviewed research on the causal relationship between military trauma and post-traumatic stress disorder.
You do not need all five of these elements. Even two or three strong pieces of evidence can support a favorable medical opinion. Upload what you have and we will assess your case.
The VA rates PTSD under Diagnostic Code 9411 using the General Rating Formula for Mental Disorders. Here are the six rating levels.
| Rating | Criteria |
|---|---|
| 100% | Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, inability to perform activities of daily living, disorientation to time or place, memory loss for names of close relatives or own name. |
| 70% | Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation, obsessional rituals, speech that is illogical or irrelevant, near-continuous panic or depression affecting ability to function, impaired impulse control, difficulty adapting to stressful circumstances, inability to establish and maintain effective relationships. |
| 50% | Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect, circumstantial or stereotyped speech, panic attacks more than once a week, difficulty understanding complex commands, impairment of short- and long-term memory, impaired judgment, impaired abstract thinking, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships. |
| 30% | Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks weekly or less, chronic sleep impairment, mild memory loss. |
| 10% | Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. |
| 0% | A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. |
PTSD affects multiple body systems. If you are already service-connected for PTSD, these conditions may qualify for secondary service connection.
Each of these conditions has an established medical literature base connecting it to PTSD through mechanisms such as chronic hyperarousal, sympathetic nervous system activation, HPA axis dysregulation, medication side effects, and behavioral changes. We write secondary nexus letters for all of these conditions.
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