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Nexus Letter


Need advice.  I do not have anyone helping me at this time with filing a PTSD/MST claim.  I do have a VSO appt. at a local vet center in a week or so.  In the meantime from what I have read you need three things to file a MST claim.  1. evidence (I have police report...check). 2. PTSD diagnosis, but you can also claim other conditions such as anxiety and depression etc...(right?).  3. Nexus letter.

Please correct or add to anything above if I am missing something.

My question today, is that although I just starting going to a civilian therapist a few months ago I have not disclosed my MST and have only talked about my daily anxiety, panic attacks etc....trying to deal with the problem without talking about the problem I guess.  When I decided to file a claim I thought I could start going to a VA mental health counselor to get therapy while at the same time getting diagnosed officially for my claim.  At this time, I do not have a document or official diagnosis of PTSD as my therapist has not told me that.  I did go to a therapist years ago who said I had PTSD, but she closed her practice and I cannot locate my records.   I know or guess it would have been better to have this long history of therapy for my PTSD claim, but I don't.   

I ended up talking to a social worker at the VA last week who is the head of the MST dept. and although I fully intended to work with therapist there for my PTSD I am already not feeling good about working with the mental health staff there (without going into any details I just need to take another route). 

My understanding is that I need the Nexus letter from a mental health person...right?  Does the Nexus letter come from a C & P exam or can you have a civilian therapist write it??  If you can have your civilian therapist write it I figure I would disclose my MST to her and start working with her in therapy then ask her to write the Nexus letter.  If I have up to a year to pull together my paperwork my therapist could write a letter a little further down the road once we discuss my issues related to my MST...right.

I think I read it's best to go to a VA therapist to get a diagnosis and Nexus letter??... but I don't feel comfortable doing that.  If I understood what I read here...you may not need to have a C & P exam if you have the evidence and a Nexus letter...even if it's from a civilian therapist...is that correct?

Anyways...sorry this email is all over the place, but hope it makes sense.

Thanks in advance for your feedback!!

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Let me accurately describe the Caluza Triangle necessary for Service connection.  You were close, but no cigar.  You need documentation (evidence) of all 3.  One or two wont cut it:  

1.  Current Diagnosis of PTSD/MST etc.  

2.  In service event, called a "stressor".   A stressor is a horrific event that happened in service, such as you saw someone decapitated, your friend was killed, you had to remove dead bodies, or, in the event of MST you were raped or sexually assuauted.  There are many stressors, not just those I listed.  

3.  Nexus, or medical link betwen your stressor and current diagnosis.  That is, a doctor needs to state that your PTSD was "at least as likely as not" caused by xx event in service.  

After you get your c and P exam, try to get a copy and see if it contains all 3, above.  Once service connected, your PTSD/MST will be rated on "symptoms".  

Edited by broncovet
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broncovet  in a MST Claim the stressor of the event waved?  I mean if there was a place and time/ date the event happen or close to the proximity  is all is needed.

Can I Get Disability Compensation for MST?

You are eligible for veterans disability compensation on the basis of military sexual trauma if you can prove:

you had an incident of military sexual trauma while on active duty

you are currently diagnosed with a mental or physical disability, and

your disabilities were caused by, or were worsened by, the military sexual trauma you suffered in service.

You cannot receive compensation on the basis of military sexual trauma alone. You must have a compensable health condition, such as post-traumatic stress disorder (PTSD), depression, anxiety disorders, panic attacks, and substance abuse.

Sometimes veterans develop post-traumatic stress disorder more from the retaliation that occurs when they report the crime than by the sexual assault itself. This is especially true for those vets who served in prior wars, such as Vietnam, before there were any resources or recognition of these types of crimes.

Following the MST you suffered, if  you were diagnosed with a personality disorder while in service, you will need to go to a VA doctor and describe all your symptoms so you can get a more accurate diagnosis. This is important to do because you cannot receive benefits for a diagnosis of personality disorder.

What Evidence Do I Need to Prove MST?

Most survivors are very unlikely to have any documentation showing that the sexual assault or harassment occurred. There is a significant stigma against reporting such assaults, and because assaults are often are not reported right away, the military has often taken no disciplinary action at all against those who perpetrated these assaults. This often means there is no record at all of what happen.

The VA understands this and does not require that service medical records contain proof of the assault or harassment.

Other forms of proof of the incident(s) that will be accepted include:

police records and/or records from rape crisis centers

pregnancy tests or tests for sexually transmitted diseases

statements from your friends in service, family members, counselors, or clergy, or

journals or diaries that you kept at the time of the trauma.

Proof of behavioral changes will also be accepted, such as:

documentation that you requested a transfer

evidence of a drug or alcohol problem

changes in job performance and/or changes in your social or economic behavior for which there is no other explanation

marital and/or sexual difficulties, or

incidents of depression or anxiety for which no other cause has been identified.

How to Apply for Disability Compensation

As a survivor of military sexual trauma, you may be entitled to expedited processing of your disability claim. Check with your  regional office  to see if they have implement VA's Fast Track 

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Dont count on the VA "waiving" the requrement of a stressor in MST cases.  If you did not promptly report the incident, or if there is no record you reported it, the burden is on you to prove it happened.  Remeber, its the Veteran's responsibility to "prove" the claim.  The VA has a "duty to assist", but the ultimate responsiblity is on the VEt.  

There is no "presumption" of MST, just because the Vet said that it happened.  The first question they will ask is "Why did you not report this (sexual assault) in your military service?  

Its going to be very tough getting MST compensation if there is no documentation of an "in service event" or "stressor".  

Sometimes the stressor requirement is relaxed during combat, but I would not count on that with MST.  

It makes sense:  If the Vet is alleging a disability from the sexual assault, then why was it not important enough at the time for the vet to report it, when it happened?    

For VA, its all about documentation.  If its not documented, then it did not happen.  This is why Alex has such a difficult time with his gun shot wound.  Apparently, he was treated in a local  hosptial not part of the military system, so he had a tough time proving it.  A scar from a GSW could happen "other than military service".  


Edited by broncovet
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broncovet excuse me,

 she has police records and  investigation reports. of this horrible trauma & IT DOES NOT MATTER WHEN THIS IS REPORTED. SHE IS REPORTING IT NOW AND THATS ALL THAT MATTERS....other than she needs to get into counseling  and Therapy Sessions.

I don't think she will need a stressor  the stressors are in the police reports with dates.

Right now she needs a DSM 5 MST PTSD Diagnoses. (From the VA MH Dept)


Here is a how a nexus needs to but in my opinion you won't need it.

  This happen while in the military right?

Example of a Nexus Letter

DATE ____________ 

Reference: (Veteran's name) ____________ 

SS# ____________________         VA File #____________________ 

To Whom It May Concern, 

I am Dr. ____________. I am board certified to practice in my specialty. My credentials are included. I have been asked to write a statement in support of the afore mentioned veterans claim. 

I have personally reviewed his medical history. (Name the Documents) I have also reviewed and have noted the circumstances and events of his military service in the years ____________ (Event or Events claimed as the cause of the condition) while he served during his military service. (List dates of service) 

Mr. ___________ is a patient under my care since (enter Date). His diagnosis is _____________ (Name the Condition). 

I am familiar with his history and have examined Mr.____________ often while he has been under my care. (Specify Lab Work, X-rays, Etc.) 

Mr.____________ has no other known risk factors that may have precipitated his current condition. 

After a review of the pertinent records it is my professional opinion that it is at least as likely as not that Mr. ____________'s condition is a direct result of his (Event) as due to his military service. (Choose the degree of likelihood with which you can concur - "at least as likely as not", "more than likely", or "highly likely") 

In my personal experience and in the medical literature it is known (Give a rationale). 


Dr. ____________

Edited by Buck52

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General Rating Formula for Mental Disorders


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; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.100%

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 which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships.70%

Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.50%

Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).30%

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.10%

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.

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