Nexus Letter for Depression
Depression is most often claimed secondary to a service-connected physical condition — chronic pain being the usual driver.
Depression claims split cleanly into two shapes. Some veterans have an in-service mental-health record and are building a direct claim. Far more are claiming depression secondary to something VA has already granted — chronic pain, a disabling orthopedic condition, tinnitus, or a serious illness — where the mental-health condition developed years after discharge. The second shape is where nexus letters do the most work, because the causal chain has to be stated by a clinician rather than assumed by a rater.
What every nexus letter must do
These four apply to every condition. A letter missing any one of them is the most common reason an otherwise good claim is denied.
- 1.A statement that your records were reviewed
VA weighs a medical opinion partly on whether the clinician actually had the evidence in front of them. A letter that does not say what was reviewed reads as an opinion formed without the file.
- 2.A current diagnosis
Service connection requires a present disability. The letter should state the diagnosis plainly rather than describing symptoms and leaving the conclusion implied.
- 3.The phrase "at least as likely as not"
This is VA's evidentiary standard — a 50 percent or greater probability. Under 38 CFR § 3.102 the tie goes to the veteran, and this phrase is what places the opinion at or above that line. Softer wording ("possibly," "may be," "could be," "cannot rule out") sits below the standard and is a leading cause of denial.
- 4.A stated medical rationale
The reasoning behind the conclusion, not just the conclusion. An opinion that gives an answer without explaining the basis for it carries little weight, no matter how well-credentialed the signer.
What depression letters must establish on top of that
- ›A current diagnosis under DSM-5 criteria by a qualified provider. VA is specific about who may diagnose a mental-health condition, and a letter from a provider outside that scope carries less weight.
- ›For a secondary claim: how the service-connected condition produces the depressive symptoms — chronic pain, lost function, lost independence, disrupted sleep — described for this patient rather than in general terms.
- ›Whether the depression is separate from, or a symptom of, an already-rated mental-health condition. VA generally rates mental-health conditions under a single evaluation, so the letter should be clear about what it is claiming.
Most common secondary pathways for depression
Under 38 CFR § 3.310, a condition caused or permanently worsened by an already-service-connected condition is itself service-connected. These are the primaries depression is most often claimed behind:
- ›Chronic pain from a service-connected orthopedic condition
- ›PTSD
- ›Tinnitus
- ›A serious or life-limiting service-connected illness
The primary has to already be service-connected. If it is not, that claim comes first.
What gets depression letters discounted
- !If VA has already rated PTSD, a separate depression rating is usually not available — the two are evaluated together. The realistic goal is often a higher single evaluation, not a second one.
- !A letter that lists symptoms without linking them to the service-connected condition gives the rater a diagnosis and no nexus.
- !Gaps in treatment are common and are not fatal, but the letter is stronger when it explains them rather than leaving them unaddressed.
Draft the depression letter — free
Our drafter builds the VA-compliant framing and language for your doctor to review, edit, and sign. It is free, there is no account and no card, and the medical judgment stays with your physician — we write the structure, not the opinion.
Draft my depression nexus letter →Opens the drafter with depression and the secondary theory already filled in. You can change both.
Also useful for depression claims
- Depression rating criteria — what each percentage requires, and what it pays.
- Real Board grants for depression — verbatim language from decisions that were actually granted.
- What nexus letters cost — what you are paying for, and when you do not need to pay at all.
- C&P exam prep — the questions the examiner will ask and how to answer them.
Nexus letters for other conditions
NexusVetClaims provides software, not legal representation or medical advice. We are not VA-accredited and never take a percentage of your benefits. A nexus letter is a medical opinion — only a qualified clinician who has evaluated you can provide one. Regulations cited here are current as published on eCFR; verify anything load-bearing against the source before you file.