A nexus letter is a medical document written by a licensed healthcare provider that connects your current medical condition to your military service. In other words, it provides the “nexus” or link between your disability and your time in the military, which is required by the VA to approve most disability claims.

To receive VA disability compensation, you must prove three things

1. Current Diagnosed Condition
2. In Service Event, Injury, or Exposure
3. Nexus: Medical Connection between 1 and 2

The nexus letter is how you prove #3. Without it, the VA may deny your claim due to lack of medical evidence connecting your condition to your service, especially if it’s not already presumed by the VA.

Mental Health Providers can diagnose and treat mental health conditions and are qualified to give a medical opinion for VA purposes.

• Licensed Professional Counselor (LPC)
• Licensed Professional Counselor – Supervisor (LPC-S)
• Licensed Clinical Social Worker (LCSW)
• Licensed Marriage and Family Therapist (LMFT)
• Clinical Psychologist (PhD or PsyD)
• Psychiatrist (MD or DO)

Medical Providers can write nexus letters for physical injuries, chronic illnesses, pain conditions, sleep apnea, toxic exposure, and more.

• Medical Doctor (MD)
• Doctor of Osteopathic Medicine (DO)
• Nurse Practitioner (NP / APRN)
• Physician Assistant (PA-C)
• Medical Specialists (Orthopedist, Neurologist, Cardiologist, Pulmonologist, etc.)
• Audiologist (for hearing loss and tinnitus claims)

Yes, the VA will accept a nexus letter from a licensed counselor, including a LPC or an LPC-S (Licensed Professional Counselor – Supervisor).

As long as the LPC or LPC-S:

• Is independently licensed in their state
• Has evaluated or treated you
• Can diagnose your mental health condition using DSM-5 standards
• Provides a written medical opinion that connects your condition to your military service
  Uses VA-appropriate language like “at least as likely as not”

An Independent Medical Opinion (IMO) for VA disability claims is a professional medical opinion written by a qualified healthcare provider who is not employed by the VA. It is used as evidence to help prove that your disability is connected to your military service.

An IMO:

• Reviews your medical records, service records, and history
• Gives a medical explanation of your condition
• States whether your disability is connected to your service
• Supports your case with medical rationale
• Uses VA-required language like “at least as likely as not” (50 percent probability or more)

Not always. You don’t always need both, but in many situations having both can make your claim much stronger.

Typically your Independent Medical Opinion and Nexus Letter will be ready within 7 days of your appointment.

The VA looks at several things when qualifying a mental health condition.

• Direct Service Connection: Caused directly by an event during military service
• Secondary Service Connection: Caused or worstened by another service-connected condition (ex: depression caused by chronic back pain)
• Aggravated by Service: Pre-existing condition made worse by service
• Presumptive: Automatically linked if you meet certain criteria (ex: POW trauma)
• MST Claims: Conditions linked to Military Sexual Trauma*

If you are diagnosed or experience symptoms of any of the following, you may be eligible for VA Disability due to a mental health condition.

• Post-Traumatic Stress Disorder (PTSD)
• Major Depressive Disorder (MDD)
• Persistent Depressive Disorder (Dysthymia)
• Adjustment Disorder
• Generalized Anxiety Disorder (GAD)
• Panic Disorder (with or without Agoraphobia)
• Social Anxiety Disorder (Social Phobia)
• Specific Phobia
• Other Specified Anxiety Disorder
• Unspecified Anxiety Disorder
• Acute Stress Disorder
• Trauma and Stressor-Related Disorder (non-PTSD trauma diagnosis)
• Obsessive-Compulsive Disorder (OCD)
• Somatic Symptom Disorder
• Illness Anxiety Disorder (Hypochondriasis)
• Conversion Disorder
• Bipolar I Disorder
• Bipolar II Disorder
• Cyclothymic Disorder
• Schizoaffective Disorder
• Schizophrenia
• Brief Psychotic Disorder
• Delusional Disorder
• Psychotic Disorder Due to Another Medical Condition
• Personality Change Due to Medical Condition (often linked to TBI)
• Neurocognitive Disorder (due to Traumatic Brain Injury)
• Cognitive Disorder NOS (older diagnosis still seen in VA claims)
• Unspecified Depressive Disorder
• Unspecified Trauma and Stressor-Related Disorder
• Other Specified Depressive Disorder

Special Notes

• *Military Sexual Trauma (MST) is not a diagnosis, but MST-related mental health conditions do qualify.
• Substance Use Disorder (alcohol or drug dependency) can qualify only as a secondary condition - for example, substance misuse caused by PTSD or depression.
• Insomnia is often rated under a mental health diagnosis if related to anxiety, PTSD, or depression.

Yes, Monarch can help you strengthen and increase your VA disability claim, especially if your case involves mental health conditions. Monarch specializes in psychological evaluations and professional medical documentation, which are often exactly what the VA needs to approve or increase a claim.

Yes, you can still qualify even if your VA disability claim was previously denied. A denial does not mean your claim is over - it just means you may need stronger evidence or a better strategy.

Yes.

Monarch provides Veteran's independent medical opinions for mental health nationwide, so you can complete the entire process from home. All Nexus Letters and Independent Medical Opinions (IMOs) from Monarch are prepared by licensed clinicians and accepted by the VA, no matter which state you live in.

Yes. Monarch’s evaluations are written to VA standards, using accepted clinical frameworks and diagnostic tools such as the CAPS-5 for PTSD.  Our clinician, Sheila Simons knows what the VA Disability raters are looking for and has an exceptionally high acceptance rate of over 99%!