Important Terminology

Disability Claim Terms

Nexus Letter: For our purposes as mental health experts, a nexus letter is a document we prepare for you that connects your current diagnosed mental health disorder to your time in service. It provides a medical opinion and makes a rational case supported by medical research that your current mental health symptoms are "at least as likely as not" related to your military service - either directly caused by your time in service, aggravated by your time in service, or are caused by a separate service-connected condition. See sections below for explanations of types of service connections. 

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DBQ (Disability Benefits Questionnaire): A DBQ is a form created by the VA and used in C&P exams. It requires the examiner to capture specific information related to the history of the veteran's claimed condition, the current diagnosis, and symptom severity/impairment level. These forms are usually completed as part of a VA C&P exam, but can also be completed by an independent examiner at the veteran's request. Completing a DBQ as part of an independent examination may be helpful if the veteran needs to establish a current diagnosis or level of impairment based on current symptoms - usually this is needed if the necessary information is not already present in the veteran's recent treatment records. For instance, if the veteran was diagnosed with depression 4 years ago but has not had treatment for depression in the intervening time, a DBQ would be helpful to establish a current diagnosis and symptom severity as required by the VA for rating purposes. The DBQ does NOT establish service connection, just the veteran's current condition. The nexus letter is required to make a connection between the current condition and the veteran's military service.

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TDIU: Veterans who have ONE service connected condition rated at 60% or above, OR a combined rating of 70% or above for two or more service connected conditions may be eligible for total disability/individual unemployability benefits. The veteran must also show that they are unable to obtain and maintain “substantially gainful employment” which refers to employment that provides adequate financial support at or above the poverty threshold. Work that falls below that threshold or odd jobs (which are known as “marginal employment”) does not disqualify someone from receiving TDIU. A letter in support of TDIU will provide necessary information about your current service-connected condition, the severity of your symptoms, and the impact of your symptoms on your ability to work. The VA has specific areas of information they require for this, and our team is well-versed in writing such letters.

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C&P (Compensation and Pension) Exam: This exam is typically scheduled through the VA or one of it's contracted partners (LHI, OptumServe, VES, etc.) when more information is needed regarding your current claimed condition. The nature and result of these exams may vary quite a bit due to contextual factors within the VA disability system (e.g. provider overload, lack of consistent training in proper exam procedure, lack of supervision, etc.) Our independent medical exams for mental health are personalized, thorough, detailed, and never rushed. We always follow best practices to provide the VA with the detailed information required to make a decision on your claim.  

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Statement in Support of Claim ("Buddy Statement"): Buddy statements are letters from people in your life who can attest to their observations of your behavior. One strength of our veterans is that they have often sacrificed their personal well-being in service of a greater cause; they get the job done no matter how they are feeling inside. But for everyone, no matter how strong, there is a time when our usual ways of coping are ineffective or become self-destructive. The people closest to you may be the ones who have the most insight into changes in behavior or emotion you've experienced as a result of your military service, and how those changes affect your everyday life. Buddy letters can be written by anyone who would have personal, direct knowledge of your behavior/personality and changes that may have resulted as a consequence of your service. 

MST (Military Sexual Trauma): Military sexual trauma (MST) is the term that the Department of Veterans Affairs uses to refer to sexual assault or repeated, threatening sexual harassment that occurred while the Veteran was in the military. It includes any sexual activity where someone is involved against his or her will – he or she may have been pressured into sexual activities (for example, with threats of negative consequences for refusing to be sexually cooperative or with implied faster promotions or better treatment in exchange for sex), may have been unable to consent to sexual activities (for example, when intoxicated), or may have been physically forced into sexual activities. Other experiences that fall into the category of MST include unwanted sexual touching or grabbing; threatening, offensive remarks about a person’s body or sexual activities; and/or threatening or unwelcome sexual advances. Dr. Miller has conducted C&P exams involving military sexual trauma and is well-versed in the VA requirements for such cases.

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"Markers": Because most MST cases are not reported through official channels, the military accepts different types of evidence in a veteran's records to support that the MST did occur. Please visit this website for further information about markers. 

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Combined Rating for mental health disorders: For veterans that suffer from multiple mental health conditions, they will receive only one rating for all issues. This is because the mental health conditions are all rated on the same scale and with the same criteria. However, this also means that veterans do not need multiple exams/DBQs/nexus letters for mental health conditions related to their military service.

Direct Service Connection

Direct service connection is a disability claim for a condition the veteran is currently experiencing that began during their time in service or shortly thereafter. This means that the veteran did NOT have the condition upon entering service, and evidence exists that the condition began during or shortly after their time in service. 

For direct service connection, a direct nexus must be established to show a 50% or higher likelihood that the veteran's experiences in service are the direct cause of their current disorder. A veteran has several ways to prove the connection based on types of available evidence, such as lay (buddy) statements, Service Treatment Records, private medical records, personnel records, naval group, squadron or battalion records, Disability Benefits Questionnaires and medical nexus opinion letters. Service medical treatment records (STRS) and personnel records are available from the National Records Center in St. Louis for providing this evidence.

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Service members seeking direct service connection for PTSD must show evidence in their military record of experiencing traumatic events in service; combat veterans who show combat experience on their DD214 are presumed to have faced traumatic events therefore direct substantiation of trauma is not required.

Secondary Service Connection

Veterans sometimes experience secondary disabling conditions as a result of their primary service-connected conditions, and as such are eligible for disability compensation. The service-connected condition often decreases the veteran's ability to sleep, exercise, socialize, participate in family activities, perform work duties, or participate in fun hobbies, which may lead to the development of mental health symptoms such as depression or anxiety. There is strong research evidence to support secondary service connections in these cases, and Dr. Miller can create a strong nexus letter using research in many instances. Some examples of mental health conditions that are secondary to common service-connected medical conditions are:

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Sleep disturbance, anxiety, depression secondary to service-connected tinnitus

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Depression/anxiety secondary to service connected chronic pain conditions like degenerative disc disease, radiculopathy, knee strain, or any other service connected condition that causes pain and impairs physical functioning

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Depression/anxiety as a result of service-connected migraine headaches

Aggravation Claims

Veterans who had mental health disorders before their time in service may have experienced that their disorders were aggravated beyond the expected level due to their military service. If your mental health condition was present before service but not indicated on your entry exam, you will need to show evidence of its pre-existence through treatment records, lay statements, or other forms of evidence. A nexus letter can help you establish that your mental health disorder was aggravated by your service. 

Other Types of Claims

Increase Claim: If you are already service-connected for a mental health condition but feel your rating percentage is too low, you can request an increase. An independent medical exam and DBQ can help establish your current symptom severity. Dr. Miller is well versed in conducting such exams and gathering accurate information according to the VA's symptom severity rating scale. 

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Supplemental Claim: Veterans whose claims have been previously denied can file a supplemental claim if new evidence becomes available to support their original claim for service connection. An independent exam, DBQ and/or nexus letter can be helpful for these types of claims to provide new evidence for the VA to review.