A real fill-in-the-blank nexus letter for VA depression claims — direct and secondary versions, plus how to use it.

Reviewed by Jonathan Teplitsky · Updated June 2026

What a depression nexus letter must contain to be effective

To move the needle on a VA claim, a depression nexus letter needs five things: the provider's credentials, a statement that they reviewed your records or claims file, a clear diagnosis, a medical rationale explaining why the link exists, and the conclusion that your depression is "at least as likely as not" related to your service or a service-connected condition. Miss any of these and the letter loses weight. The rest of this page gives you a real, fill-in-the-blank template you can hand to your provider.

What a nexus letter is — and why depression is usually a secondary claim

A nexus letter is a doctor's written medical opinion that connects a diagnosed condition to its cause. For VA purposes that cause is either direct (something that happened in service) or secondary (another already service-connected condition). Depression is most often filed as a secondary claim, because it commonly develops because of another disability — chronic back or knee pain, tinnitus, sleep apnea, a disfiguring injury, or PTSD. Living with constant pain or ringing in the ears wears people down, and the resulting depression is compensable when a provider ties it to that service-connected root. If you want the foundations first, see what is a nexus letter and our VA depression rating guide.

The 5 elements of a strong nexus letter

• Credentials. Who the provider is, their license/specialty, and why they are qualified to give the opinion.
• Records reviewed. A statement that they reviewed your service records, medical history, and/or C-file — not just a single visit.
• Diagnosis. The specific condition, e.g., major depressive disorder per DSM-5 (rated under Diagnostic Code 9434).
• Rationale. The medical "because" — the reasoning and any literature explaining why the depression is connected to its cause. This is the heart of the letter.
• Conclusion. The "at least as likely as not" opinion stating the link.

The "at least as likely as not" standard

VA does not require certainty. Service connection only needs a probability of 50% or greater — phrased as "at least as likely as not." Because of the benefit-of-the-doubt rule in 38 CFR 3.102, when the evidence is in equipoise (a 50/50 tie) VA must decide in the veteran's favor. That is why this exact wording matters: vaguer phrases like "could be related" or "possibly connected" fall below the threshold and give a rater room to deny.

Weight tip: The conclusion sentence alone is not enough. A bare "it is at least as likely as not" with no reasoning is given little probative value. The rationale — the explanation of the medical mechanism — is what makes the opinion persuasive to a rater or the Board.

Fill-in-the-blank nexus letter template

Copy the version that fits your claim, replace every [bracketed] placeholder, and have your provider review, complete, and sign it on their letterhead.

Secondary depression (most common)

[Provider Name], [Credentials/License] · [Clinic / Address] · [Date]

RE: [Veteran Name], [VA File Number / SSN]

I am a [psychiatrist / psychologist / physician / NP] licensed in [State], with [X] years treating [mental health / the relevant field]. I have reviewed [Veteran]'s service treatment records, VA medical records, and claims file (C-file).

[Veteran] is diagnosed with [major depressive disorder] per DSM-5 criteria. [Veteran] is service-connected for [primary condition, e.g., chronic lumbar strain] at [XX]%.

It is my professional medical opinion that [Veteran]'s [depression] is at least as likely as not (50% or greater probability) caused by, or alternatively aggravated beyond its natural progression by, the service-connected [primary condition].

Rationale: [Explain the mechanism — e.g., persistent pain from the service-connected condition has limited activity, disrupted sleep, and led to documented loss of interest and depressed mood beginning in [date]. Cite the chronology in the records and any supporting medical literature.]

Sincerely, [Signature] · [Provider Name, Credentials]

Direct service connection

[Same header and credentials block as above.]

It is my professional medical opinion that [Veteran]'s [major depressive disorder] is at least as likely as not (50% or greater probability) related to [his/her] active military service.

Rationale: [Tie the depression to an in-service event, stressor, or documented symptom — e.g., records show treatment for low mood in [year] during service, symptoms have been continuous since, and the clinical picture is consistent with onset during that period.]

Sincerely, [Signature] · [Provider Name, Credentials]

Who can write it

The opinion must come from a qualified medical provider — typically a psychiatrist, psychologist, primary-care physician, or in many cases a nurse practitioner or physician assistant. It can be your treating provider or an independent provider you hire. A statement the veteran writes about their own symptoms is valuable as a lay statement, but it is not a medical nexus and cannot replace the provider's signed opinion.

How depression is rated (DC 9434)

Depression is rated under 38 CFR 4.130, Diagnostic Code 9434, using the General Rating Formula for Mental Disorders:

Common mistakes that sink nexus letters

• Using weak language ("could be," "possibly") instead of "at least as likely as not."
• Stating the conclusion with no rationale — the reasoning is what gives the opinion weight.
• No statement that the records or C-file were reviewed.
• Forgetting the secondary aggravation path — a service-connected condition can worsen existing depression even if it did not cause it.
• An unsigned letter, or one signed by the veteran rather than a provider.

Important: This is an educational template, not legal or medical advice. The nexus letter must be completed, reviewed, and signed by a qualified medical provider. For help with a denial or appeal, see whether you need a VA appeals attorney.