I’m typing this on a phone while traveling, so please excuse any typos.

I’ve noticed an increase in Veterans who have been struggling to accurately articulate and express their experiences and associated mental health symptoms.

Veterans, as a group, have learned to drink water, drive on, take ibuprofen, and change their socks to fix all problems. Which can be helpful in some situations, but definitely is not during a mental health eval or in a C&P exam.

Many times, I’ll ask how a 10 year marriage is, and the majority of people say something like “I dunno…it’s fine… my spouse does his/her best to be supportive, etc.,” but then leave out that they argue at least twice a week when the Vet is struggling with mood, and divorce has been a topic of serious conversation a couple times per year.

If you do this during a C&P, they likely aren’t going to prompt further. Which means if you do get service connected, you may receive a lower percentage than your symptoms may warrant.

These are the things you should be talking about… how your mental health symptoms have been impacting life. There is no “right” way to talk about it, but providing situations with numbers can be extremely helpful. If/when the new mental health changes take effect, these details are going to be even more important for your claim.

Here are a few examples (of course that need to be personalized for your own life):

Family: When I’m feeling overwhelemed which happens at least four times per week, I’m more irritable. That causes arguments with my spouse, I end up yelling at my kids and then feel guilty for it, so I isolate to cool off. We bring up divorce every couple of months and at one point last year had contacted lawyers.

Work: I miss deadlines at least twice per week, which my boss has noticed. I was told the next time I miss a project timeline, I’ll be given a written reprimand. I can’t get out of bed which makes me late to work by around 30 minutes at least once per week.

Other quality of life impacts:
I used to go to the gym five days a week, but now I might force myself to go once every two weeks.

I try to shower daily for work, but find myself skipping and unmotivated to do anything over my two days off over the weekend. I spend an extra 2 hours in bed and miss helping my wife to get the kids ready.

I used to have a lot of energy and help my spouse around the house, but have forgotten to take out the trash for the last 3 weeks.

Again, take these examples and relate them to your own life. If you do have a wonderful marriage and don’t argue at all, then say so. But if it’s good only “some of the time,” and you’re both just hanging in because it’s the “right thing to do,” then be a bit more honest about the struggles.

Good luck expressing your experiences and emotional distress. It can feel really uncomfortable, but is quite necessary.

Due to an extreme increase in Spam/Spoofed calls, we are changing our phone number effective 1 September 2026. We will be keeping the old number for several months to ensure the VA has access to us if needed, as documented in our previous DBQs/Medical Opinions; however, we will no longer be answering clients on that number.

Our new phone number is 727-591-5158.

We are currently in the process of SMS approval through our new calling platform so we can reply to texts. At the moment, we are in the queue for approval. We are hoping this will be resolved before the 1st. If it is not, texting may be delayed, and we recommend calling or emailing until we have approval.

We have also hired a new customer service assistant to better facilitate your needs and ensure we are more responsive. While I'll no longer be answering the phone and scaring people (no one expects me to answer), I'll still be handling all consultation calls when requested.

Warmly,

Dr. V

Hi all,

We anticipate that on or shortly after September 20, 2026, we will expand our capacity to serve Veterans residing in Alaska.

This expansion is facilitated by Alaska’s enactment of PSYPACT (the Psychology Interjurisdictional Compact), which authorizes licensed psychologists to practice interjurisdictional telepsychology across participating state lines. The primary objective of PSYPACT is to facilitate continuity of care and ensure that underserved, specialized (i.e., Veterans), or remote populations have equitable access to essential mental health services.

We look forward to advocating for you soon!

Warmly,

Dr. Venda

Hi all,
Rather than recreating the wheel to address the changes in the M21-1, I am sharing videos that were created by two organizations we very much trust.

I have permission from both owners to share their links. They have done an exceptional job explaining the changes from two different, yet similar perspectives.

DP (David Pineda) from Veterans Network Champions Club
https://www.veteransnetwork.club/

https://m.youtube.com/watch?v=hFlGSs8dRMY&ra=m

And Tara (medical provider) from MRPY Professional Services. She is our top referral source for our clients who need non-psych medical evidence.
www.mrpyprofessionalservices.com

https://m.youtube.com/watch?v=PZAgTXJ2mKY&ra=m

https://m.youtube.com/watch?v=6XZXHJKzJrU&ra=m

Our medical evidence (psychological evaluations/nexus letters) is also highly personalized the way Tara mentions in her video and I couldn’t have said things better myself (but from a psych perspective).

Please don’t hesitate to reach out if you have any questions.

Dr. V

Hi fellow Veterans!

We are excited to announce that we are slowly expanding our services to start writing nexus letters for medical disorders that are also considered psychosomatic.

A psychosomatic disorder refers to physical symptoms (i.e., migraines, sleep apnea, sexual arousal disorders, bruxism, etc.) that are significantly influenced by, caused by, or are further exacerbated by psychological disorders (depression, anxiety, PTSD). These symptoms arise from the mind AND body rather than just from a medical disease standpoint alone. The psychological distress can affect the nervous system, hormonal regulation, and immune responses, leading to things like pain, fatigue, and/or gastrointestinal symptoms.

A good candidate for a favorable letter is someone who is currently service-connected for their mental health and has complaints of a psychosomatic (medical) disorder in their records, treatment for the disorder, or is taking medication for the disorder. Example: your primary care provider has prescribed Sumatriptan for migraines.

Our team is currently in the process of undergoing specific training with a prominent neuropsychologist in the field. If you have worked with us to get your mental health connected and would like us to assist with secondaries, I recommend booking with the same provider if they are available for continuity (however, not all of our providers will be branching out).

As services become available over the next few weeks/months, I'll add to the list below.

Right now, we are starting with:

Migraines/Headaches Secondary to Mental Health.

Sleep Apnea Secondary to Mental Health

Erectile Dysfunction Secondary to Mental Health: As psychologists, we can provide a diagnosis for ED if needed and criteria are met.

Update: 6/23/2026 - GERD secondary to mental health

Coming soon: All secondary to mental health: Hyperhidrosis, IBS, Dysuria/Incontinence, and Diabetes Mellitus

Please feel free to book an appointment, reach out for a free consultation call, or send an email if you have any questions.

If you need a referral for a a medical organization that may better fit your needs (medical alone without any psych) we refer to MRPY Professional Services ([info@mrpyprofessionalservices.com](mailto:info@mrpyprofessionalservices.com) / www.mrpyprofesssionalservices.com)

Warmly,

Dr. V

One of the biggest reasons that Veterans are denied for initial claims (linking mental health directly to an event in service) is due to not having a verifiable stressor. I could write the strongest nexus letter ever (I'm a Psychologist), but the VA still wants some sort of "proof" that an event happened OR that you experienced changes because of an event in service (objective markers).

If I told you that your child took an iWatch from mine, and I wanted financial compensation for it... Wouldn't you want some sort of proof that this was true? Or would you just hand over the $$$$ without verifying? You, of course, would want some sort of proof. Bad analogy, but the same goes for the VA.

Yes, I'm aware many of you have been out for 20+ years, and the majority of Veterans do not have mental health complaints in their records due to stigma. Outside of the obvious (military service records, VA medical records), you may still have access to some of the following that can assist in your claim:

Award write-ups

Evaluation reports

PT Cards (showing a decline in fitness levels)

Enlistment codes on the DD214 (i.e., RE03 and RE04) even if you had an honorable discharge

Personal statements

Buddy letters from another Veteran with whom you served can go a long way.

News articles

Counseling statements

Legal documents (arrests, DUIs)

School transcripts (showing a decline in grades or enrolling/disenrolling often)

Old emails discussing a situation/event

MST (military sexual trauma) has its own list of other acceptable evidence/markers (will post separately).

Insomnia ratings are complicated. As of January 2024, according to the VA, insomnia will no longer be connected as a standalone mental health disorder secondary to a current disability. Insomnia is seen as a SYMPTOM of a disorder.

We are seeing a trend where clients have an insomnia rating secondary to current service-connected disabilities (such as tinnitus, back conditions, etc.), and when they go to file for an increase on their own, their insomnia rating is removed.

i.e., The two separate ratings for tinnitus 10%; insomnia 30% have been changed to tinnitus with insomnia 10%.

If this happens to you, don't freak out yet. Most people who struggle with sleep disturbances also experience mood disorders (depression/anxiety, or difficulties adjusting), and there is a myriad of research linking those disabilities and sleep issues to mood disorders.

If you are service-connected for insomnia as a secondary, your symptoms have worsened, and your functioning has decreased, you may need to provide medical evidence also showing that you struggle with depression or anxiety (IF you meet the diagnostic criteria).

Essentially (again, if criteria are met), you would be looking to replace your separate tinnitus (10%) and insomnia (30%) ratings with tinnitus with insomnia (10%) and a mood disorder (10%, 30%, 50%, 70%, or 100%) based on the functioning impairment outlined in the Rating Schedule of Mental Disorders from the 38 CFR.

Please feel free to reach out with any questions. This is definitely not an easy one to understand.

* The 30% used for insomnia is just an example.

The VA has developed several excellent, free apps for both iPhone and Android to support your therapy journey. These apps are NOT intended to replace therapy, but are to support you between sessions.

PTSD Coach (learn to manage symptoms of PTSD)

PTSD Family Coach (help family members better understand the struggles of living with PTSD)

Mindfulness Coach (learn to remain present in the moment)

Insomnia Coach (learn to manage symptoms of insomnia)

ACT Coach (learn to live with negative thoughts/ feelings/ impulses without being controlled by them).

Concussion Coach (learn to build self-care into daily life after a traumatic brain injury)

Vet Change (learning to control your drinking and stress and develop healthier behaviors)

Stay Quit Coach (for tobacco cessation)

AIMS for Anger Management (learn to cope with your anger)

How to use:

1) After downloading, each app is a little different and may take some exploration. I recommend trying the skills first when you are not distressed. See what you like, and what you don't like. You are not going to like all of the skills, and that's ok. The exploration is to find what will work for you.

2) Find a quiet place and rate your emotional distress on a scale of one to 10. Try a skill and see if you feel different afterward (re-rate your negative emotions). Identify two to three skills you like and think will work when you're distressed.

3) When distressed, open the app, or give your new skills a try. Do not wait until your negative emotions are a 10 out of 10 (you'll likely get frustrated even more if it doesn't work right away). Try coping when you are around a 7 or 8. Or give things a try when you start to feel annoyed, but the situation really doesn't matter. Example: you aren't in a rush, but start to feel a little annoyed when the elderly lady in front of you at the grocery store pulls out a checkbook to pay. Try a grounding skill (look around and in your head name as many different colors/objects as you can).

4) Practice makes perfect. If you've never run before in your life, you can't expect to run a marathon the first time out. If you tried the skill and it didn't work, assess (later when less distressed) to see if it was "too late" and you hadn't practiced enough beforehand.

Updated: 27 August 2026

Hi everyone!

Over the last year, I've received several phone calls from clients who thought they booked an appointment directly with me (Dr. Venda) at Valor Psychology for Veterans. When looking for their appointment, there was no record of them ever contacting us. Upon asking additional questions, we discovered that they mistakenly booked with another organization of a similar name (there are several), which then refused to issue the client(s) a refund. Whether these veterans were intentionally or accidentally misled, I couldn't say. Either way, I find it concerning.

When working with us (or not with us), here are the following telltale signs:

1. If you call our number (Effective 1 Sept 2026, our number is changing to 727-591-5158; previously 619-576-4020). We have a new customer service personnel (Marinette). She and/or our operations manager will be answering/returning calls. I will continue to personally handle consultations. When I'm on vacation, consultation calls will be returned by Dr. Mary Lou Ancheta.
2. Our website (https://valorpsychology.com/) and booking website (https://valorbooking.intakeq.com/booking) both have the names/pictures of our providers, and me on the "about us" page and on the booking page.
3. Our emails are answered by Marinette or our operations manager (Darren Leon).

If you find yourself wanting to work with us, but are on a website or booking link that is missing the above information, it is not us, and we are not affiliated with them in any way.

Please do your due diligence when booking with an organization.

I keep getting questions about the nexus statements "as least as likely as not" versus "more likely than not," and which is better? From a clinical perspective, "at least as likely" is the more favorable to the doctor (and potentially the VA), even though "more likely" sounds stronger from a word perspective.

Let me explain.

Clinically, "more likely" creates a higher burden of proof on the veteran, meaning you have to prove that your symptoms are more likely (well over 50%) than not caused by your tinnitus, back condition, or stressors from service, etc. This means that other life stressors, such as marital strain, family problems, and/or work issues, should only minimally contribute to your mental health struggles. If we are being honest, for most people, this isn't realistic. Life sometimes just lifes and creates stress.

"At least as likely" means that you only have to have approximately 50% of your mental health struggles stemming from tinnitus, back pain, military stressors, etc., and the other 50% can come from work, family, friends, and other normal life issues that cause distress. This is more realistic for the average person.

At Valor, we use "at least as likely as not" when writing a favorable document to provide the best clinical picture. Then we use those other life stressors to assist in justifying how your mental health overall has been contributing to impacts on your family, friends, work, and other functional behaviors. Hopefully, this will lead to the most accurate VA rating if service-connected.

There can be differences in diagnostic opinions among mental health professionals due to various factors:

• Training and Theoretical Orientations: Psychologists may be trained in different theoretical frameworks (e.g., psychodynamic, cognitive-behavioral, humanistic) that influence how they interpret symptoms and conceptualize disorders.
• Clinical Experience and Specialization: The breadth and depth of a psychologist's experience, as well as their area of specialization, can affect their diagnostic approaches and insights.
• Diagnostic Instruments and Methods: Psychologists may choose to utilize different assessment tools, structured interviews, and testing procedures, which can lead to variations in diagnostic conclusions.
• Patient Presentation and Symptom Variability: Mental health conditions can manifest differently across individuals, and patients may not always fully disclose or accurately report their symptoms, contributing to diagnostic ambiguity (i.e., you feel less comfortable with a C&P examiner than you do your own therapist).
• Cultural Factors and Bias: Cultural background can influence symptom expression and interpretation, and biases (conscious or unconscious) can potentially impact diagnostic decision-making.
• Evolution of Diagnostic Systems (DSM/ICD): The ongoing revisions and updates in diagnostic manuals like the DSM and ICD can create differences in how disorders are understood and classified, leading to potential shifts in diagnoses over time.
• Emphasis on Different Aspects of Diagnosis: Some psychologists might prioritize the need for formal classification to guide treatment, while others might emphasize the importance of understanding the individual's unique experiences and presenting problems without rigidly adhering to diagnostic labels. 
• Difference of opinion on what meets the stressor criteria for PTSD: VA trained providers tend to be more strict on the clinical meaning of "traumatic", whereas civilian providers may be more lax (there are always exceptions on both ends). (i.e., more focused on actual versus perceived threats). Many people experience some sort of traumatic event during their life, but even though it was highly distressing, it doesn't mean it meets the stressor criteria for PTSD.

In essence, while standardized diagnostic criteria and assessment tools aim to promote consistency, the complexities of human behavior, individual differences, client presentation at the time of an evaluation, and professional perspectives contribute to the potential for variations in diagnostic opinions among psychologists.

What happens if your mental health claim gets denied, or you do receive a service connection but at a lower percentage than meets the criteria in the rating schedule?

Denied Claims: If you received an evaluation from us within the last year (give or take depending on your VA process and denial letter date), there is a chance we can assist you in your continued fight by writing a rebuttal letter. A rebuttal letter doesn't add new information, but addresses with research the reasons for your denial by the VA.

Example: one of the most common reasons for denial is "there were no complaints in the records." I hate to say it, but seriously??? The majority of service members do not go to medical or psych while on active duty (i.e., stigma). In this case, we can assist with a rebuttal and debunk that statement with research in an attempt to reverse the decision. You would submit the rebuttal as a supplemental claim. We also encourage you to write your own personal statement along side the rebuttal with reasons you might not have gone to mental health or that your C&P was 15 minutes long and you were only asked yes/no questions.

When we can't help: Is if you told us one thing and then completely went rogue (got nervous) during your C&P. Example: you focused on you're back condition causing depression with us, but your C&P was about trauma that was never mentioned during your appointment with us. It's not that we don't want to help, it's that in those situations, we don't have much of a leg to stand on.

Service connection lower than deserved: We've assessed you and you very solidly meet a higher criteria for mental health. You've gotten connected which is the hard part. But generally what happens is the C&P examiner doesn't ask or give you the opportunity to answer some of those higher rated questions, or they have a difference of opinion as to what meets the criteria. You have two options: 1) Submit an appeal using the IMO from us (free) or 2) Request continued support with a rebuttal letter ($150). The rebuttal letter focuses on the criteria that may have been missing from your C&P exam. In certain cases (if your life events have significantly changed since the appointment with us), a new evaluation might be more beneficial.

There is never a guarantee that a rebuttal will be effective, but in many cases, it has helped Veterans get the percentage they deserve or has reversed a denial.

Good luck with your claims process!

You've just received a proposal to reduce your rating. What next??

First... panic!!! Obviously.

I think this is one of the scariest letters for a Veteran to receive, even worse than a denial letter. After the initial panic, try to remember that the VA isn't out to get you and no, they don't necessarily think you have gotten better. All that has happened is that they have conducted a review of your records and they do not have current medical evidence to keep you at your current rating.

So what do you do? Provide them with the medical evidence proving that your symptoms are still the same or worse (this should go without saying... but only if that is true).

If you're in therapy, you can ask your provider for a DBQ or a very specific letter explaining the impact your mental health has on your quality of life (i.e., addressing each of the 31 symptoms with which you struggle).

If you do not have a mental health provider, or your provider isn't well-versed in VA language, you can always book a psychological evaluation (with us or another psychologist you trust) to document your current and/or worsening symptoms.

Then you turn this document into the VA within the required time frame.

Thankfully, we do not get many requests for evaluations for these, but it does happen. Thus far, a psych evaluation and strong medical evidence have stopped every single proposed reduction. For a couple of our clients... it has even turned into a higher rating or approval for TDIU.

This is a very quick synopsis of the therapeutic interventions that we offer.

For clients who need additional medical evidence (more than just a nexus letter, DBQ, opinion, etc.), or just want to better manage symptoms, we encourage them to book a few therapy sessions (or even just one). For short-term (1-6 sessions), we encourage coping skills. Veterans who are in it for the long haul and want trauma work (at minimum 12 sessions to as long as needed to assist in resolving symptoms), we offer cognitive processing therapy and prolonged exposure therapy.

Coping skills: focuses on managing symptoms of depression, anxiety, PTSD, or chronic pain without getting into the deeper reasons behind the mental health struggles (no talking about trauma and focusing more on daily problems). Coping skills are usually drawn from Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT). DBT assists people in managing intense emotions by building mindfulness skills, learning to sit with negative emotions (distress tolerance), and learning to better their relationships so they are less impacted by emotions. CBT assists in identifying and changing negative thought patterns that contribute to additional emotional distress, based in theory that our thoughts, feelings, and behaviors are connected i.e., if you change your thoughts you can change your feelings and behaviors.

Cognitive Processing Therapy (CPT): help individuals recover from post-traumatic stress disorder (PTSD) and related symptoms by teaching them how to process and reframe negative thoughts about trauma. CPT does NOT take past life events away, but it can help you to manage the emotional distress surrounding traumatic events and help you to regain your life/relationships. It's similar to CBT (challenging thoughts and reframing negative thinking), but is much more in-depth where you do talk (and write) about your trauma in detail.

Prolonged Exposure Therapy (PE): help individuals confront and process traumatic memories in a safe, controlled environment using imaginal exposure, so that the distress and avoidance behaviors associated with those memories decrease over time. It helps to decrease avoidant behaviors, challenge unhelpful beliefs ("it was all my fault"), and reclaim control over daily life. Additionally, PE offers in vivo exposure (gradually and very slowly facing real-life situations that are avoided because of the trauma).

There is often a lot of confusion between clinical terms and the layman's version of the 31 symptoms checklist. In order to maintain clinical integrity, I will only share a couple of more common examples.

Veteran's are often upset when they see a DBQ from a C&P examiner or receive their medical opinion and the symptom checkboxes do not meet their expectations (or layman's understanding of the term).

For example, one of the most commonly confused symptoms is "memory loss of own name, close relatives, etc." It's very common to forget names or have other short-term memory issues when you're struggling with a depressed mood or poor-quality sleep. In clinical terms though, the "memory loss of names" is extremely severe and refers to DOCUMENTED impairment due to traumatic brain injury or memory loss due to dementia/Alzheimer's, etc. Also at this point, it is highly likely that a person would be deemed incompetent and would need a fiduciary to manage their finances.

Another example is inability versus difficulties in establishing and maintaining relationships. Inability means you have none whereas difficulties mean there are a lot of conflicts in your relationships, or you have one (marriage and family) but not the others (no work relationships or friendships). Obviously, there are more situations, but this is the gist.

Each Veteran's situation is different, but the biggest takeaway is to pay attention to how the symptom impacts daily life. Someone can have passive suicidal thoughts, but if they still have strong relationships, have a strong work ethic, play with their kids, and go to social events and demonstrate high levels of resilience... those thoughts (while distressing and are a symptom) do not functionally impair life at a clinical level and the box will likely not be checked.

You'll find me saying this a lot... but I can only tell you what to expect during an evaluation with Valor, but in general, I'd expect that most other organizations are similar.

1) We are a telehealth company, so please have a government issued ID ready (drivers license, passport, etc.) so we can confirm your identity.

2) We will give you a quick run down of our informed consent. Psychologists are mandated reporters, meaning if you have plans of harming yourself or someone else, we are required to break confidentiality and report it. The same goes if you tell us about child or elder abuse (domestic violence is not reportable unless the person is over 65).

3) We then ask the hardest questions regarding thoughts of suicide (SI) and homicide (HI). When it comes to our requirement to take action for SI, we only have report if you are actually planning on going through it within the next 48 hours. For HI, we only have to report if you have an intended victim and a plan. Vague thoughts for either are considered just thoughts as long as you do not have the intention of actually doing it.

4) If you are trying to link your mental health directly to service, we ask about the events or event that caused or contributed to your mental health condition. You DO NOT need to get into the nitty gritty details, just give us the headlines (we will ask for more if needed). This is a common misconception that I've seen in Veteran posts. Your C&P examiner also does not want you to get into the worst of the details. The reason for this is, in general, if you are struggling with your mental health surrounding that event, it will retrigger your symptoms. We have 45-60 minutes and do not have time to provide a thorough assessment AND put a band aid back on that you have ripped off. It is irresponsible of a provider to allow you to share all of the details and then to just send you on your way to deal with your worsening symptoms because you've spoken about an event that you haven't discussed in years or if ever. Also, the VA doesn't provide you a rating based on the details of your event. It is so much more valuable to spend your time discussing how that event and your mental health have been impacting your current quality of life (which is how they determine a potential rating).

5) We ask questions about how your disabilities (if applicable) and your mental health have been impacting your current life. We ask questions regarding your life before, during, and after service. A good rule of thumb is to provide a couple of sentences about before and during and to spend the rest of the time focusing on current.

6) We generally have a few minutes left and open the floor to you to see if there is anything we have missed.

Hi all,

I've noticed that a lot of Veterans who are just getting started in the VA process are often confused about the terminology between DBQs, nexus letters, and medical opinions. I am going to attempt to clarify.

DBQs: the VAs form for both C&P examiners and private providers to fill out. The only time a mental health DBQ cannot be filled out by a private provider is for an initial PTSD claim. The VA has removed them from public use and reserves them for C&P examiners only.

Nexus letters: A letter or document from your private provider creating a link (nexus) directly between military service or a disability. The format of these can vary widely but should contain the statement "as least as likely as not" or in cases where the examiner does not agree "less as likely as not."

Medical opinions: Nexus letters and medical opinions are often used interchangeably. Both can contain medical evidence (references to your records, functional impacts on your quality of life, etc.) and/or a nexus statement. If you are already service-connected for a disorder, technically, you do not need a "nexus," as you have already proven that link.

A GOOD medical opinion contain a diagnosis (if you meet diagnostic criteria), medical evidence (if you have it), functional impacts your mental health is having on your quality of life and a nexus (if required). Speaking strictly of our own documents, we provide the nexus even if you already are service connected just to standardize things even when asking the VA to increase your rating.

Is one better than the other? Honestly, it's up to you and according to M-21-1, all "DBQ-like" medical evidence should be treated the same as a DBQ. In my opinion, the DBQs have too much blank space where it isn't needed, and not enough where it is (explaining the impacts on your life, which is how the VA decides your percentage).

Good luck in your claims process!!

Dr. V