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If you’re a veteran pursuing VA disability benefits, understanding the role of a Nexus Letter to support your VA claim is mission critical!
Nexus Letters are often the key piece of documentation needed to establish service-connection between your military service and the claimed condition—or to connect a new secondary condition to another service-connected disability rated at 0% or higher.
However, there’s a lot of confusion around whether VA doctors can (or will) write these letters.
In this blog post, VA disability expert Brian Reese explains what Nexus Letters are, why VA doctors typically won’t write them for veterans, how this could impact your VA disability claim, as well as your options to get Nexus Letters from private healthcare providers.
Let’s begin!
Table of Contents
4-Minute Video: Brian Reese Reveals If VA Doctors Can or Will Write Nexus Letters for Veterans!
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Summary of Key Points
- Essential Role of Nexus Letters: Nexus Letters are mission critical for veterans’ VA disability claims, providing the needed link between military service and the claimed condition, especially for conditions not documented during service or those needing secondary service-connection.
- Limitations of VA Doctors for Nexus Letters: VA-employed doctors and contracted C&P examiners are generally not allowed to write Nexus Letters due to a lack of independence, as they are bound by VA policies, creating a conflict of interest. Since they work for the VA, they are not considered “independent” experts for the purpose of writing an Independent Medical Opinion (IMO) for a veteran.
- Medical Opinion Versus Independent Medical Opinion: Medical Opinions (MOs) from VA-employed doctors and C&P examiners differ from Independent Medical Opinions (IMOs) or Nexus Letters, which must come from unbiased, expert-level private healthcare providers to effectively establish service-connection.
- Steps to Obtain a High-Quality Nexus Letter: Veterans are advised to seek qualified private providers for Nexus Letters, following a recommended six-step process outlined below to find a reputable Nexus Letter provider, gather necessary records, review the draft, and submit the letter to the VA to strengthen their claim.
What is a Nexus Letter for VA Disability?
A Nexus Letter is an evidence-based document (advisory type opinion) prepared by a private medical professional that helps to establish a link or connection (“Nexus”) between the veteran’s current disability and their active-duty military service. A Nexus Letter can also be used to establish secondary service-connection and service-connection via aggravation.
Pro Tip: Not all Nexus Letters are created equally nor are they offered equal weight by the VA. Some have higher probative value than others.
Should I Get a Nexus Letter for My VA Claim?
While a Nexus Letter isn’t mandatory, there are specific situations where obtaining one is strongly advised.
Here’s a simple way to decide if you need a Nexus Letter for your VA claim:
- If your disability was diagnosed during service, and it’s in your military medical records (Service Treatment Records), you probably do not need a Nexus Letter. Why? Because you have medical evidence that the disability existed during your military service.
- If your disability was not diagnosed during service or if there are no documented symptoms in your military medical records, you probably do need a Nexus Letter. Why? Because you don’t have medical evidence that the disability existed during service.
- If you’re attempting to service-connect a previously denied VA claim or trying to file for secondary service-connection, a Nexus Letter is highly recommended. Why? Because you need a powerful argument to overcome a previous VA claim denial. In addition, secondary service-connection requires Medical Nexus Evidence that your new disability is “proximately due to” or “aggravated by” a current service-connected disability.
Why VA Doctors Typically Won’t Write Nexus Letters
Most VA doctors will not write Nexus Letters for veterans.
According to 38 CFR 3.328, VA healthcare providers are not considered “independent” medical experts for purposes of providing an independent medical opinion to support a veterans VA disability claim.
Rather, this independent medical opinion must come from a qualified medical expert not employed by the VA.
This means VA employees are not appropriate sources to write Nexus Letters for veterans.
#1. Lack of Independence
VA doctors are employed by the VA, which creates a perceived conflict of interest in providing an opinion that directly affects VA claims.
Because these physicians are “hired in the service of VA,” they are bound by VA policies and may not be able to offer objective opinions, particularly those related to causation for service-connection.
#2. Role of Contracted C&P Examiners
Contracted Compensation and Pension (C&P) examiners, often from third-party companies, are also bound by VA guidelines and are not regarded as independent experts for Nexus Letters.
Like VA doctors, contracted C&P examiners cannot provide an unbiased “independent” medical opinion for veterans’ claims due to their contractual relationship with the VA.
However, they are authorized to provide their “medical opinion” for service-connection at the C&P exam.
Note: A “medical opinion” is very different from an “independent medical opinion (IMO).”
Understanding the Difference Between a Medical Opinion and an Independent Medical Opinion (IMO)
A Medical Opinion (MO) and an Independent Medical Opinion (IMO) serve different roles in VA disability claims.
Here’s a quick breakdown of each:
- Medical Opinion (MO): An MO is provided by the C&P examiner during your C&P exam to address whether a veteran’s condition could be connected to service. However, these opinions are not considered “independent” due to the relationship between the C&P examiner and the VA.
- Independent Medical Opinion (IMO): An IMO, or Nexus Letter, is prepared by a private medical provider who is not affiliated with the VA. The provider reviews the veteran’s military service, medical history, and other pertinent details to craft an objective and credible IMO, often using terms like “at least as likely as not” to suggest a probable connection between the veteran’s condition and their military service.
VHA Directive 1134(2) and the Role of VA Providers in Assisting Veterans with Medical Evidence for VA Disability Claims
VHA Directive 1134(2), amended May 11, 2020, mandates that VA providers assist veterans with completing medical forms, such as Disability Benefits Questionnaires (DBQs) and other statements about their medical condition.
However, this directive clarifies that VA providers are not responsible for making causality determinations required in Nexus Letters.
When it comes to documenting medical conditions, VA providers can record current diagnoses, prognosis, and functionality, but they cannot provide opinions directly linking those conditions to military service due to the inherent conflict of interest.
How to Find Doctors Who Write Nexus Letters (6-Step Process)
Here’s a 6-step process to find the right Nexus Letter doctor near you, obtain a high-quality Nexus Letter with high probative value, and submit it to the VA:
Step #1: Search Online for VA Nexus Letters
Start with a simple Google Search for “VA Nexus Letters.”
This will give you a variety of providers who offer Nexus Letter services for VA disability claims.
Step #2: Read Customer Reviews and Testimonials
Research the specific doctor or company offering Nexus Letter services.
Reviews and testimonials can provide valuable insights into the quality, timeliness, and pricing of their services.
Additionally, checking online message boards like Quora and Reddit can offer candid feedback from other veterans about their experiences with these providers.
Step #3: Submit an Online Inquiry or Book a Free Consultation
Many Nexus Letter doctors offer a no-obligation consultation or the opportunity to submit an online inquiry before making any commitments.
This step helps clarify if they can meet your needs.
Step #4: Book Your Appointment
After deciding on a provider, book your appointment.
Gather all relevant medical and military records for the doctor’s review.
Many providers charge a records review fee to determine if they can assist you before proceeding with the full Nexus Letter service.
Step #5: Nexus Letter Review, Approval, and Delivery
A reputable Nexus Letter doctor will provide a draft for your review before finalizing the document.
Ensure the letter accurately reflects your medical condition and service history.
Step #6: Submit Your Nexus Letter With Your VA Claim
Once you have obtained and reviewed your Nexus Letter, submit it as part of your VA disability claim.
Ensure all supporting documents, such as medical records and service treatment records, are included.
This comprehensive submission helps establish a strong case for service-connection and enhances the likelihood of a favorable decision from the VA.
Are Nexus Letters FREE for VA Disability Claims?
Nexus Letters are not free!
Private healthcare providers who specialize in VA disability medical evidence don’t offer their services for free; they charge a fee.
You’re paying for the doctor’s time, expertise, and credentials.
While it’s possible to have your own private doctor (e.g., your private primary care doctor) write a Nexus Letter for free, be cautious.
If the medical professional writing the Nexus Letter is not experienced in VA disability claims, regardless of their credentials, they might miss crucial elements, which could weaken your evidence and hurt your chances of approval.
How Much Is a Nexus Letter Right Now?
A Nexus Letter from a VA disability medical evidence expert typically costs between $1,500 and $2,000 right now.
Prices can vary, with some providers charging less and others more.
Most providers charge a flat fee upfront, while some others work on a contingency basis, only charging if your VA claim is successful.
Remember, quality is essential; sometimes, you get what you pay for, so choose your Nexus Letter provider carefully!
Do You Need a Nexus Letter for Your VA Disability Claim?
Are you looking to obtain a high-quality Nexus Letter to link your condition to your military service or to an existing service-connected disability for secondary service connection?
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Veterans who become members of the VA Claims Insider Elite program can get access to our preferred provider network who can potentially write VA Nexus Letters at reduced rates.
Why pay $1,500 to $2,000 for a Nexus Letter when you can get one for $595?
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About the Author
Brian Reese
Brian Reese is a world-renowned VA disability benefits expert and the #1 bestselling author of VA Claim Secrets and You Deserve It. Motivated by his own frustration with the VA claim process, Brian founded VA Claims Insider to help disabled veterans secure their VA disability compensation faster, regardless of their past struggles with the VA. Since 2013, he has positively impacted the lives of over 10 million military, veterans, and their families.
A former active-duty Air Force officer, Brian has extensive experience leading diverse teams in challenging international environments, including a combat tour in Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy and earned his MBA from Oklahoma State University’s Spears School of Business, where he was a National Honor Scholar, ranking in the top 1% of his class.
