For Tillamook County Veterans

If you live in Tillamook County, the cost of your nexus letter may be covered directly through the Tillamook County Veterans Services Office. Through an arrangement with my practice, Tillamook County Veterans pursuing a mental health disability claim may be able to receive their nexus letter at no out-of-pocket cost.

How to start: You can reach out either way - contact me directly to begin the conversation, or contact the Tillamook County Veterans Services Officer to confirm your eligibility. Either path leads to the same comprehensive process: intake call, records review, clinical evaluation, draft letter, and final signed letter.

Tillamook County Veterans Services

Phone: (503) 842-4358

Email: ntorres@co.tillamook.or.us

Web: tillamookcounty.gov/veterans-services

What is a nexus letter, and why does it matter?

A nexus letter is a written professional opinion that connects your current mental health diagnosis to your military service. The VA uses a specific legal standard, “at least as likely as not,” and a letter that does not use that language, or that lacks the clinical rationale to support it, is often dismissed or under-weighted by the rater reviewing your claim.

A strong nexus letter typically includes:

• A current mental health diagnosis made under DSM-5-TR criteria

• A clear statement of opinion using the “at least as likely as not” standard

• Specific, evidence-based rationale tying your symptoms to your service: an in-service stressor, military sexual trauma, combat exposure, training incident, or sustained hostile environment

• A review of relevant records: service treatment records, personnel records, post-service mental health treatment, and lay statements

• The credentials of the clinician writing the letter

Without those pieces, even a real and legitimate claim can be denied.

Conditions I write for

I write nexus letters for service-connection or increase claims related to:

• Post-traumatic stress disorder (PTSD), including combat-related and Military Sexual Trauma (MST)

• Major depressive disorder

• Generalized anxiety disorder and other anxiety conditions

• Adjustment disorders related to service or transition

• Complex trauma presentations that may not fit neatly into a single diagnostic category

How my process works

Free 15-minute intake call. We talk through your service history, what you are claiming, and what evidence you already have. If I am not the right clinician for your situation, I tell you on this call before any money changes hands.

Records review. I review your service treatment records, personnel records, prior VA decisions, and any existing mental health treatment records you can provide. The more complete the records, the stronger the letter.

Clinical evaluation. We meet for a comprehensive trauma-informed assessment. This is typically 90 to 120 minutes and can be via telehealth within Oregon or in-person at my Beaverton or Oceanside office. This is a real clinical interview, not a checklist.

Draft letter. I write the letter, integrating the records, the clinical evaluation, and the appropriate legal standard. You receive a draft to review for factual accuracy.

Final letter. Once we have confirmed the facts are correct, I issue the signed final letter for your claim file.

What I will and will not promise

I will write the strongest letter your clinical picture supports. I will use the VA’s required language, cite my reasoning, and tie the opinion to specific evidence. I will be honest with you about what your records will and will not allow me to say.

I will not write opinions my clinical evaluation does not support, regardless of what outcome a Veteran is hoping for. I cannot guarantee the VA will approve your claim; no clinician can do that. What I can promise is that the letter you receive will be a serious clinical document, written by someone who understands both the diagnostic side and the shared lived experience of military service.

Pricing and Logistics

Fee. Flat $1,500 for a complete nexus letter package: intake call, records review, clinical evaluation, draft letter, and final signed letter.

Format. Telehealth throughout Oregon, or in-person at my Beaverton or Oceanside office.

Turnaround time. Letters are typically issued within 3 to 4 weeks of clinical evaluation.

Records. Please plan to provide service treatment records, personnel records, and any prior VA decisions ahead of the clinical evaluation.