What is a Nexus Letter? (With VA Nexus Letter Example)
Updated Dec. 17, 2024
A nexus letter is an official document signed by a medical expert establishing a connection between an in-service stressor and a current condition. To understand why that matters, let’s review the three key elements of successful VA claims:
A current, diagnosed disability
An in-service stressor (an injury, illness, traumatic event, etc.)
A connection linking parts 1 and 2
A nexus letter may help you accomplish the all-important third step—the service connection.
In both initial claims and appeals cases, nexus letters can be a deciding factor for whether your claim or appeal is granted. But what is a nexus letter, what’s included in one, and how do you get one? Here, we’ll dive deeper into nexus letters, answer your questions, and end with a sampleVA nexus letter. Let’s get to it!
VA Nexus Letter Requirements
A VA nexus letter should include four key elements:
Medical expertise. Your nexus letter should be written by a medical expert in the area of your medical condition in question and include a statement verifying that fact. Additionally, the physician writing the nexus letter must assert that they have fully and thoroughly reviewed your medical records including your VA claims folder (also known as your C-file).
Evidence. Your nexus letter should include additional evidence vouching for your disability, such as buddy letters, prior medical records, and your military service records.
Research that supports the physician’s conclusions. This could be references to studies published in medical journals and other accounts in medical literature.
A conclusion—although it doesn’t need to be an explicit recommendation. The writer of your nexus letter simply needs to determine whether your in-service stressor is "more likely than not" to have caused your current condition. Anything less strongly worded will not suffice.
While this may sound like a lot, VA nexus letters are typically quite short, as you’ll see in the example nexus letter at the bottom of this post.
Who Can Write a Nexus Letter?
Your nexus letter must be written by a medical expert. This is in contrast to other types of testimony that can help a claim or appeal, like a buddy letter, which can be written by anyone who knows you and has observed you over some period of time.
Further, your nexus letter should be written by a medical specialist related to your condition. So, if you’re claiming or appealing for benefits for PTSD, you should try to get a nexus letter from a clinical psychiatrist or psychologist. Likewise, nexus letters for bone injuries and cancer should be written by orthopedic surgeons and oncologists, respectively.
The specialization is incredibly important because the VA uses it to assign probative value. This means that the VA uses medical credentials to help determine the trustworthiness of the nexus letter’s author. When a person has the credentials of a medical specialty, it gives their opinion more credibility than a general practitioner or family doctor.
Finally, in the ideal case, your nexus letter should be written by the physician who has treated you or your condition the longest. This is because the VA’s assessment of probative value takes into account how long you’ve been treated by that physician. If your relationship with the physician is shorter, it may call into question the accuracy of the medical history they’re working with.
What Should You Do if Your Physician Won’t Write You a Nexus Letter?
As we just mentioned, your nexus letter should ideally be written by a physician or specialist who has treated you before. However, not all physicians and specialists are comfortable writing one. Even if they are, they may not have the time to do so.
If you can’t find a physician to write your medical nexus letter, you still have a couple options:
An independent medical examiner (IME) will usually be able to provide a nexus letter. Keep in mind that IMEs can be expensive, often charging anywhere from a thousand to several thousand dollars. Additionally, understand that if the IME is found to have a low probative value, their nexus letter may actually hurt your case rather than help it.
An option that may be more efficient is to consult with a Veterans’ Benefits Appeals attorney who can advise you on a sound course of action based on your personal circumstances.
Common Questions About VA Nexus Letters
Understanding the importance and intricacies of medical nexus letters is essential for your claim’s success. To provide further clarity, let’s take a look at some frequently-asked questions on the topic of medical nexus letters.
When Do You Need a Nexus Letter for VA Claims?
Nexus letters are helpful for most VA claims and appeals. Nexus letters will be most beneficial when you’re filing or appealing a secondary service-connected claim (a new claim that’s related to a service-connected condition you have), and for any claims that aren’t covered by presumptive conditions.
Can You Win an Appeal Without a Medical Nexus Letter?
Yes, but it may be harder. When an appeal is rejected, it’s often because it never clearly established the service connection to the current condition. A medical nexus letter doesn’t guarantee that you’ll win your appeal, but it can increase the likelihood of receiving a positive result.
Does a Nexus Letter Improve Your Chances of Receiving a Favorable Rating or Winning an Appeal?
Not necessarily. Nexus letters can be strong pieces of evidence, but that doesn’t mean that they always are. A number of factors can influence the impact your nexus letter has on your claim or appeal, including:
The author’s medical authority and specialization.
How clearly they make a connection between your disability and stressor, and evidence they use to support that connection.
Your relationship with your physician and their knowledge of your medical history.
When Should You Submit Your Nexus Letter?
You should submit your medical nexus letter with your initial VA claim. If you didn’t do that and your claim was denied, submit it with your appeal.
If you’ve been denied benefits, getting in touch with a Veterans’ Benefits Appeals lawyer can help you file an effective appeal including your nexus letter.
What Should You Do if Your VA Claim is Denied With a Nexus Letter?
A nexus letter may help your claim, but it’s not guaranteed to bring you the desired result. Even if you include a medical nexus letter in your original VA benefits claim, there are a number of factors that could cause your claim to be denied.
If your claim is denied, don’t give up the fight. Get in touch with the Law Office of Michael D.J. Eisenberg today. With over 16 years of experience handling Veterans’ benefits matters, Mr. Eisenberg has the knowledge to help you craft a compelling appeal and can advise you on how to effectively establish the service connection for your condition.
Note: Consultations for Veterans’ Benefits Appeals Matters are free; however, consultations for Military Records Issues and Medical/Physical Evaluation Boards are paid.
VA Nexus Letter Example
The following is an example of a medical nexus letter that your physician can refer to. Remember that nexus letters are only valid when written by a medical expert, and that your medical nexus letter should be personalized to your experience and condition.
[Your Name]
[Address]
[Date]
To whom it may concern,
I, Dr. [Name], am writing this letter in support of [Veteran's name]'s application for disability benefits. I am a board-certified specialist in [specialty], and my CV is enclosed.
I have been providing medical care to [Veteran's name] since [date]. The veteran has been diagnosed with [Medical Condition] and has been under my direct care for [time frame]. I have thoroughly reviewed [Veteran's name]'s medical history, including [name of documents], his VA C-File, and their military service records.
Based on my expertise and the available medical evidence, it is evident that the [event or events] experienced by [Veteran's name] during their military service significantly contributed to the development and worsening of their current medical condition. The [event or events] are known to be associated with [explain association between event and medical condition].
Throughout my professional relationship with [Veteran's name], I have conducted various medical examinations, laboratory tests, and imaging studies, such as [specify relevant tests]. These diagnostic assessments have consistently supported the connection between [Veteran's name]'s military service and their current medical condition.
It is crucial to note that [Veteran's name] does not possess any other known risk factors that could have caused or contributed to the development of their condition. This further strengthens the argument for a direct link between their military service and their medical condition.
Considering my experience as a [specialty] and my thorough analysis of the medical literature, it is my professional opinion that it is more likely than not that [Veteran's Name]'s current medical condition is a direct [or indirect] result of the [event or events] encountered during their military service.
Should you require any additional information or further documentation, please do not hesitate to contact me. I am available for any inquiries regarding [Veteran's name]'s medical condition and its connection to their military service.
Sincerely,
[Name], MD
[Specialty]
[Contact information]
[Medical office address]