As stated previously, for service connection of PTSD three elements are required.
- The veteran must have a current diagnosis of PTSD
- The in-service event/stressors must be supported by credible evidence
- A connection (called a nexus) between the current diagnosis of PTSD and the in-service event/stressor must be supported by medical evidence.
This article will focus on the third element: Nexus between a diagnosis of PTSD and the in-service stressor.
The final element of a service-connected PTSD claim is the connection (nexus) between the in-service stressor and the diagnosis. This is often referred to as the Nexus Letter. There are four requirements for a good nexus letter.
- This letter must come from a medical professional with expertise in the subject matter.
- The letter must discuss the veteran’s relevant medical history from the time of service to present, and
- The letter must state that it is more likely than not that the cause or aggravation of the PTSD occurred in service, and
- The letter must give a reasonable explanation for the connection.
Because PTSD can manifest and be diagnosed long after the stressor event, a discussion of the veteran’s relevant medical history in the nexus letter is necessary to identify the stressor and the time symptoms began. The medical history may start with military records but many times the more relevant records are treatment and symptom records from after the veteran left the military.
The VA has an “at least as likely as not” standard for granting claims. This means that the nexus letter must state at least a 50 percent certainty that the veteran’s PTSD stems from the in-service stressor. A better way of stating the certainty would be that the stressor is “more likely than not” to have caused the PTSD.
The final, and most important part, of the nexus letter, is the explanation the doctor gives for the connection. A nexus letter that addresses the first and second requirements but fails to provide adequate reasoning will not be accepted by the VA. The explanation showing the relationship between the in-service stressor and the diagnosis should be clear and concise and contain supporting documentation from relevant medical literature.