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June 30, 2020

VA Nexus Letter Tips – The Art and Science of a Credible Nexus Letter

Last updated on March 31, 2021

A high-quality, credible VA Nexus Letter written by a qualified medical professional is arguably #1 way for veterans to prove service-connection, aka, the “Nexus” requirement under the law.

Many veterans are denied service connection by the VA because they failed to show a clear nexus (logical link or connection) between a current disability and their active duty military service.  

But regardless of how many times you’ve been denied service connection, there is still hope!

Enter the VA Nexus Letter.

>> Looking for a Doctor Who Can Write a VA Nexus Letter? <<

What is a “Nexus” for a VA disability claim?

According to the VA, a “Nexus” is simply a logical link or connection between a veteran’s current disability and an in-service incident, event, or injury.

To be eligible for VA disability compensation benefits under the law, a veteran must prove that their disability was caused or made worse by their active duty military service.

Did you know that a VA Nexus Letter and an Independent Medical Opinion (IMO) are the SAME THING (the terms are sometimes used interchangeably)?

In our experience, a credible VA Nexus Letter is the single most crucial document a veteran can provide the C&P examiner and VA Rater to help prove service connection on an “at least as likely as not” basis.

Yep, a high-quality, credible Nexus Letter really is the single, most powerful way to prove service connection!

What is a VA Nexus Letter?

A VA Nexus Letter is an evidence-based document prepared by a competent and credible medical professional that helps to establish a “connection” between the veteran’s current disability and their active duty military service.

A VA Nexus Letter is often the “essential” piece of credible evidence needed to help a veteran get their VA disability condition service connected under the law.

WATCH: What is a Nexus Letter?

WATCH: What is a VA Nexus Letter?

Why do I say this?

Because VA disability claims are won or lost because on MEDICAL EVIDENCE.

Either you have enough medical evidence or you don’t!

A great VA nexus letter IS medical evidence and can influence the C&P examiner’s medical opinion, as well as the VA Rating Official’s final disability decision, due to the medical nexus evidence provided in the letter.

>> Want to find Doctors Who Write VA Nexus Letters for Veterans? Click HERE now. <<

4 Key Elements of a VA Nexus Letter

VA Nexus Letter Key #1: The doctor should list any supporting evidence reviewed

The nexus letter doctor should reference any medical or personnel records reviewed, such as service treatment records, VA medical records, private treatment records, DD 214, or any other existing evidence of record.

Medical Nexus Letter Key #2: The doctor must offer supporting, evidence-based rationale

The most credible VA nexus letters list medical research studies, scientific journals, or previous BVA case law precedent that describes the medical etiology of the veteran’s condition, and the relationship to the veteran’s military service.

This is especially important for direct service connection, secondary service connection, and presumptive service connection because medical etiology, also known as a “showing of causation,” is important to help a veteran prove service connection under the law.

VA Medical Nexus Letter Key #3: The doctor should give a strong medical nexus opinion

Make sure the medical professional writes one of five statements of likelihood in the VA nexus letter to help the veteran prove service connection under the law, preferably, the words “more likely than not.”

VA Nexus Letter Key #4: The doctor should list his/her credentials, such as job title and specialty

The doctor must sign and date their name, in addition to listing his/her medical credentials, such as, Oncologist, Orthopedic Surgeon, Sleep Specialist, PA-C, MD, etc.

This is a particularly important part of the VA nexus letter because it helps the VA Rating Official determine if it’s competent and credible for VA rating purposes.

The 5 Statements of Likelihood for a VA Nexus Letter

When asked to give an independent medical opinion as to whether a veteran’s condition is related to a specific incident during military service or another service-connected disability, the medical professional should express his/her medical nexus opinion with one of the following 5 statements of likelihood:

#1 “Is due to” (100% sure)

The VA nexus opinion “is due to” means the doctor is 100% certain that a veteran’s condition was caused or made worse by active duty service or by another service-connected disability for secondary service connection.

#2 “More likely than not” (greater than 50%)

The nexus opinion “more likely than not” means the doctor believes there is a greater than 50% chance that a veteran’s condition was caused or made worse by active duty service or by another service-connected disability for secondary service connection.

#3 “At least as likely as not” (equal to 50%)

The VA nexus letter opinion “at least as likely as not” means the doctor thinks there is an approximate even balance of medical evidence for and against, and thus, there is a 50/50 chance that a veteran’s condition was caused or made worse by active duty service or by another service-connected disability for secondary service connection.

This is the minimum nexus statement that will help a veteran prove service connection, because the Benefit of the Doubt always goes to the veteran according to VA law.

When all things are equal, tie goes to the veteran!  

#4 “Less likely than not” (less than 50%)

The nexus opinion “less likely than not” means the doctor thinks there is a less than 50% chance that a veteran’s condition was caused or made worse by active duty service or by another service-connected disability for secondary service connection.

This statement will likely cause the VA Rater to deny service connection, unless one or more other medical opinions carry more weight (higher probative value) or contain different medical opinions.

#5 “Is not due to” (0% chance)

The nexus opinion “is not due to” means the doctor thinks there is a 0% chance that a veteran’s condition was caused or made worse by active duty service or by another service-connected disability for secondary service connection.

This statement will cause the VA Rater to deny service connection.

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About the Author

Brian Reese
Brian Reese

Brian Reese

Founder & CEO

Brian Reese is VA disability expert, former Air Force captain, and founder of VA Claims Insider – “The Most Trusted Name in Education-Based Resources for Veterans.”

His frustration with the 8-step VA disability claims process led him to create “VA Claims Insider,” which provides U.S. military veterans with tips, strategies, and lessons learned for successfully submitting or re-submitting a winning VA disability compensation claim.

Brian is also the CEO of Military Disability Made Easy, which is the world’s largest free searchable database for all things related to DoD disability and VA disability claims and has served more than 4,600,000 military members and veterans since its founding in 2013.

His eBook, the “9 Secrets Strategies for Winning Your VA Disability Claim” has been downloaded more than 300,000 times in the past three years and is the #1 rated free VA disability claims guide for veterans.

He is a former active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in 2011 supporting Operation ENDURING FREEDOM.

Brian is a Distinguished Graduate of Management from the United States Air Force Academy, Colorado Springs, CO and he holds an MBA from Oklahoma State University’s Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class).

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