A Nexus Letter is essential in the VA disability claims process, often serving as the crucial evidence to prove service connection for a veteran’s condition.
It acts as a bridge connecting a veteran’s current medical issues to their military service or another service-connected condition, especially for secondary conditions like sleep apnea secondary to PTSD.
This article will detail the key elements of a high-quality Nexus Letter, provide a downloadable sample, and offer pro tips and strategies to strengthen your VA claim.
Table of Contents
Summary of Key Points
- A well-crafted Nexus Letter is crucial in VA disability claims, linking a veteran’s condition to military service or another service-connected condition for secondary service connection.
- An effective Nexus Letter should include clear identification, the provider’s credentials, a comprehensive review of medical history, an independent medical opinion, evidence-based rationale, and the provider’s signature and contact information.
- Nexus Letters for VA disability claims can be written by Nurse Practitioners (NPs), Physician Assistants (PAs), and Medical Doctors (MDs). Mental health Nexus Letters are best written by Psychologists or Psychiatrists.
- While a Nexus Letter strengthens a VA claim, it does not guarantee service connection.
What is a Nexus Letter?
According to VA disability benefits expert Brian Reese:
“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.”
– Brian Reese
Pro Tip: Not all Nexus Letters are created equally nor are they offered equal weight by the VA. Some have more probative value than others.
Key Elements of an Effective VA Nexus Letter
The most effective Nexus Letters include the following information:
- Clear Identification: The letter should clearly state the veteran’s name, date of birth, and VA file number (veteran’s SSN) for accurate identification.
- Provider’s Credentials: It’s crucial that the medical professional includes their qualifications, such as medical degree, specialization, and experience with VA disability evaluations, to establish credibility. Including a copy of the medical professional’s resume or Curriculum Vitae (CV) can further support the Nexus Letter by providing a detailed overview of their qualifications and expertise. This additional documentation helps ensure that the VA considers the letter’s findings seriously and gives the veteran’s claim the appropriate weight during evaluation.
- Medical History Review: The Nexus Letter should reflect a comprehensive review of the veteran’s medical records, including service treatment records, post-service medical records, and the veteran’s entire VA Claims File (C-File), if available.
- Detailed Independent Medical Opinion: The letter must provide an independent medical opinion that explicitly connects the veteran’s current disability to their military service or a service-connected condition for secondary claims. At a minimum, the opinion should state that the condition is “at least as likely as not” related to service, explaining the medical rationale behind this conclusion. “At least as likely as not” is the minimum VA standard for approving service connection. It means there’s an equal balance of evidence for and against (50/50) and the tie goes to the veteran.
- Convincing Evidence-Based Rationale: The Nexus Letter should include references to medical literature, studies, or guidelines that support the connection between the veteran’s condition and their military service or a service-connected condition. This can’t just be the provider’s opinion. This section needs to include evidence-based rationale to support the connection.
- Significance and Clarity: The letter should be clear and concise, avoiding medical jargon where possible, and clearly articulate the connection between the veteran’s condition and their service, ensuring it is easily understood by VA claims adjudicators. There is no specific length requirement.
- Signature and Date: The medical professional must sign and date the Nexus Letter to ensure its authenticity and official nature. Additionally, include the provider’s contact information, such as phone number and email address, in case the VA needs to follow up with the medical professional for further clarification or questions. This information enhances the letter’s credibility and provides a direct line for any necessary communication.
These elements ensure the Nexus Letter provides strong, evidence-based support for the veteran’s disability claim, increasing the likelihood of a favorable VA decision.
Who Can Write a Nexus Letter?
Nexus Letters for VA disability claims can be written by Nurse Practitioners (NPs), Physician Assistants (PAs), and Medical Doctors (MDs).
For mental health conditions, it is strongly recommended to have the letter written by a Psychologist (PhD or PsyD) or Psychiatrist (MD or DO) due to their specialized training in diagnosing and treating psychiatric disorders.
Should I Get a Nexus Letter for My VA Claim?
A Nexus Letter can be submitted at any stage of the VA claim process, but it’s often most effective when provided at the initial claim submission, during an increase claim, or in the Supplemental Claim or Board Appeals process.
Here’s a simple litmus test to determine if you should get a Nexus Letter:
- Condition Diagnosed During Service: If your disability was diagnosed during service and is documented in your Service Treatment Records, you likely don’t need a Nexus Letter. This documentation serves as evidence of the disability’s existence during your military service. However, if you’ve been out of the military for more than 12-months and there’s gaps in your records (e.g., you haven’t been seen for the condition for 18 months), you might want to get a Nexus Letter.
- Condition Not Diagnosed During Service: If your disability wasn’t diagnosed during service or lacks documented symptoms in your military medical records, you probably need a Nexus Letter. This is essential to establish a connection between your current condition and your service, filling in gaps where medical evidence from your service period is lacking.
- Previously Denied Claims or Secondary Claims: A Nexus Letter is highly recommended if you’re trying to service connect a previously denied VA claim or file for secondary service connection. It provides a strong argument to overcome a prior denial and is crucial for proving that a new disability is “proximately due to” or “aggravated by” an existing service-connected condition.
Does a Nexus Letter Guarantee Service Connection?
No, a Nexus Letter does not guarantee service connection for a VA disability claim.
While a well-written Nexus Letter can significantly strengthen a claim by providing medical evidence linking a veteran’s current condition to their service, it does not ensure approval.
The VA considers various factors, including medical evidence, service records, and the overall credibility of the claim, when making a decision.
A Nexus Letter is a crucial piece of evidence, but it is one part of the overall evaluation process.
Sample Nexus Letter [Download]
Here’s a downloadable Nexus Letter template and example for Sleep Apnea Secondary to PTSD:
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.
