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Trauma can affect you for decades after the stressor event
Understanding PTSD and MST Nexus Letters
Most people are familiar with combat service causing PTSD. However, there are many circumstances that can lead to service connection for PTSD.
Post Traumatic Stress Disorder (PTSD) Nexus Letters
PTSD can be caused by more than combat
Combat is not the only cause of PTSD. Veterans may develop PTSD after experiencing many different types of traumatic events during service, including events that occur during recruit training, stateside duty, deployment preparation, military police work, medical duties, emergency response duties, or other non-combat military assignments.
Examples of non-combat PTSD stressors may include:
- A near-death experience during military service
- Threatened or actual physical assault, including physical attack, robbery, mugging, or domestic violence
- Rape, sexual assault, or other acts of sexual violence, including Military Sexual Trauma
- A severe motor vehicle accident, rollover, aircraft incident, or training accident
- Natural or human-made disasters
- Witnessing a medical catastrophe involving another person
- Traumatic medical events, such as waking during surgery, anaphylactic shock, traumatic childbirth, or hospitalization in an intensive care unit (ICU) for a life-threatening condition
- A medical catastrophe involving one’s child
- Gruesome incidents observed by first responders, rescue teams, military police, medics, corpsmen, firefighters, EMTs, or paramedics
- Witnessing the serious injury, unnatural death, or physical or sexual abuse of another person
Many veterans do not realize that PTSD can be caused by non-combat traumatic events. Some veterans dismiss their trauma because they were not deployed to combat, were not physically injured, or believe that “others had it worse.” However, witnessed trauma, threatened death, serious injury, sexual trauma, and catastrophic events can all be psychologically significant.
A well-supported nexus letter may help clarify that medical connection. Becoming service-connected for these non-combat stressors is possible. A well-supported nexus letter may help strengthen a claim by explaining the medical connection between the veteran’s current symptoms and the in-service traumatic event.
Military Sexual Trauma (MST) Nexus Letters
MST affects women and men
Military Sexual Trauma, or MST, can affect both women and men. MST may include 1) sexual assault; 2) sexual harassment; 3) coercion; 4) threats; or 5) unwanted sexual contact that occurred during military service.
It can be incredibly difficult to become service connected for Military Sexual Trauma (MST) because most people very rarely report their sexual assault, or other MST event, at the time of occurrence due to understandable feelings of humiliation, shock, emotional pain, worry about being blamed, fear of not being believed, concern about retaliation, and limits of confidentiality. A nexus letter can help. The VA has outlined marker evidence that they will accept in place of direct evidence of a reported sexual assault while in-service. This list includes:
A. Visits to a medical or counseling clinic or dispensary without a specific diagnosis or specific ailment.
B. Sudden requests that the veteran’s military occupational specialty or duty assignment be changed without other justification.
C. Lay statements indicating increased use or abuse of leave without an apparent reason such as family obligations or family illness.
D. Changes in performance and performance evaluations.
E. Lay statements describing episodes of depression, panic attacks or anxiety but no identifiable reasons for the episodes.
F. Increased or decreased use of prescription medications.
G. Increased use of over-the-counter medications.
H. Increased disregard for military or civilian authority.
I. Obsessive behavior such as overeating or under eating.
J. Pregnancy tests around the time of the incident.
K. Increased interest in tests for sexually transmitted diseases.
L. Unexplained economic or social behavior changes.
M. Treatment for physical injuries around the time of the claimed trauma but not reported as a result of the trauma.
N. Breakup of primary relationship.
A persuasive nexus letter discusses the marker evidence and provides an analysis linking behaviors and changes to the MST event. Dr. Allen will carefully and thoroughly review your records to describe marker evidence that can be added to your nexus letter to support your claim.
How PTSD-MST Nexus Letter May Help
A PTSD or MST nexus letter is a medical opinion that explains whether a veteran’s current mental health condition is at least as likely as not related to military service.
A strong nexus letter should be individualized. It should discuss:
- The veteran’s specific traumatic event or stressor
- The veteran’s current diagnosis
- Symptoms that developed after the trauma
- The veteran's marker evidence
- Current functional impairment
- Relevant service records, medical records, and lay statements
- Alternative explanations considered
- The medical reasoning connecting the veteran’s current condition to service
A nexus letter should not simply state that PTSD exists. It should explain why the veteran’s symptoms, history, records, and trauma exposure support the medical opinion.
Dr. Jessica Allen is a psychiatrist and former VA Compensation and Pension examiner with experience evaluating mental health conditions in the context of VA disability claims. She understands that discussing MST can be painful, humiliating, and difficult even years after the trauma occurred.
Dr. Allen approaches MST nexus letters with sensitivity, clinical objectivity, and careful attention to the evidence. Her review may include service treatment records, military personnel records, mental health treatment records, lay statements, prior VA decisions, C&P examinations, and any available evidence of behavioral or emotional changes after the traumatic event.
In MST claims, Dr. Allen carefully reviews:
- The veteran’s specific traumatic event or stressor
- The veteran’s current diagnosis
- The veteran's marker evidence
- Symptoms that developed after the trauma
- The veteran's marker evidence
- Current functional impairment
- Relevant service records, medical records, and lay statements
- Alternative explanations considered
- The medical reasoning connecting the veteran’s current condition to service
A strong MST nexus letter should do more than list symptoms. It should explain how the veteran’s history, records, marker evidence, diagnosis, and current functional impairment support the medical opinion.
Dr. Allen’s goal is to provide a clear, individualized medical opinion explaining whether the veteran’s current PTSD or other mental health condition is at least as likely as not related to MST during service.
Secondary Conditions
What Can I Claim Secondary to PTSD?
- Obstructive Sleep Apnea Nexus Letters
- Migraine Headaches Nexus Letters
- Gastroesophageal reflux disease (GERD) Nexus Letters
- Irritable Bowel Syndrome Nexus Letters
- Fibromyalgia Nexus Letters
- Chronic Fatigue Syndrome Nexus Letters
- Hypertension Nexus Letters
- Temporomandibular Joint Dysfunction (TMD) Nexus Letters
- Erectile Dysfunction (ED) Nexus Letters
- Female Sexual Arousal Disorder Nexus Letters
We provide nexus letters for all of these conditions and more!