What is the Success Rate of a VA Disability Claim With a Nexus Letter?

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There is no exact “success rate” for a VA disability claim with a Nexus Letter.

However, a strong Nexus Letter with high probative value from a VA disability medical expert can increase the likelihood of VA claim approval.

Keep in mind that a Nexus Letter does not guarantee that the VA will approve your claim.

That said, even if the VA denies your initial claim with a Nexus Letter, many denials are overturned in the veteran’s favor during the appeals process, such as a Higher-Level Review (HLR) or Supplemental Claim.

Summary of Key Points

• Nexus Letter Success Rates: While there is no exact success rate for VA disability claims with a Nexus Letter, a well-written Nexus Letter from a qualified medical expert can significantly improve approval chances, especially for cases involving secondary service connection or previous denials. Many denials are later overturned on appeal with strong Nexus Letter evidence.

• Nexus Letter Defined: A Nexus Letter is an evidence-based independent medical opinion written by a licensed healthcare provider to establish a link between a veteran’s condition and military service. It is commonly used to support claims for direct service connection, secondary service connection, and service connection via aggravation, especially when evidence in service treatment records is lacking.

• Importance of High-Quality Nexus Letters: A strong Nexus Letter must be thorough, factual, and evidence-based, citing medical records, research, and BVA decisions. It should include a statement like “at least as likely as not” to demonstrate a 50/50 probability of service connection. High-probative-value letters increase approval chances but do not guarantee success.

• Dealing with VA Claim Denials and Appeals: Even with a strong Nexus Letter, claims may be denied due to gaps in treatment history, bad C&P exams, or errors. Veterans can challenge denials through a Higher-Level Review (HLR), Supplemental Claim, or Board Appeal, submitting additional evidence like clarifications from Nexus Letter providers or expert rebuttals to unfavorable C&P exam results.

What is a VA Nexus Letter?

According to VA disability 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.

Pro Tip: Not all Nexus Letters are equal, and the VA gives more weight to those with high probative value. A strong Nexus Letter should be thorough, factual, and evidence-based, citing medical records, research, and BVA decisions. It must include a statement like “at least as likely as not” to show a 50/50 (tie goes to the runner) link between the condition and military service.

Who Can Write a Nexus Letter for a VA Disability Claim?

A Nexus Letter can be written by a licensed medical professional, such as:

• Nurse Practitioner (NP)

• Physician Assistant (PA)

• Psychologist or Psychiatrist (for mental health conditions)

• Medical Doctor (MD)

• Specialists relevant to the veteran’s disability (e.g., Orthopedists, Neurologists)

The provider should have expertise in the condition being evaluated and include specific medical evidence to support their conclusions.

What Makes a Nexus Letter High-Quality and Effective?

A high-quality Nexus Letter should be detailed, factual, and evidence-based.

It should include all the following:

• List all records reviewed, showing thorough analysis to boost credibility.

• Clearly state the medical provider’s qualifications and expertise.

• Provide a logical and evidence-based supported rationale connecting the veteran’s condition to military service.

• Include references to the latest medical research, BVA decisions, and the veteran’s medical history.

• Use the phrase “at least as likely as not” to establish a 50/50 probability of service connection.

Do You Need a Nexus Letter for a VA Disability Claim?

No, you aren’t required to get a Nexus Letter for your VA claim.

However, there are some specific situations where obtaining one is strongly advised.

Here’s a simple way to decide if you should get a Nexus Letter for your VA disability 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.

When Should You Get a Nexus Letter for a VA Claim?

You should consider obtaining a Nexus Letter if:

• Your disability was not diagnosed during active service, and there is no record of symptoms in your Service Treatment Records (STRs).

• There is a gap in symptom continuity (no consistent treatment for the condition), and you have been out of the military for more than 12 months.

• Your VA claim was previously denied, and you need stronger evidence to overturn the decision during the appeals process.

• You are filing for secondary service connection, linking a new disability to a condition already service-connected.

• You are attempting to prove service connection by aggravation for a pre-existing condition worsened by military service.

Is a Nexus Letter Required for Secondary Service Connection Claims?

While not required, a Nexus Letter is highly recommended to help establish secondary service connection.

Why?

Because a Nexus Letter for a secondary condition helps establish a medical link or connection between the primary service-connected condition and the new secondary condition.

Pro Tip: If you’re filing a secondary VA claim, a Nexus Letter is strongly recommended. Why? Because secondary service connection requires “Medical Nexus Evidence” that your new disability is proximately due to, caused, or aggravated by a current service-connected disability. A Nexus Letter helps prove these requirements for your secondary claim to the VA.

What is the Nexus Letter Success Rate for VA Disability Claims?

There is no exact “success rate” percentage for a VA disability claim with a Nexus Letter because the VA evaluates each claim based on the totality and probative value of the evidence provided.

However, a well-written Nexus Letter with high probative value—prepared by a qualified medical professional—can increase the likelihood of approval.

Does a High-Quality Nexus Letter Guarantee Approval of a VA Disability Claim?

No, a high-quality Nexus Letter does not guarantee approval of a VA disability claim.

While a Nexus Letter can significantly strengthen your case by providing a clear medical link between your condition and military service, it is only one piece of evidence considered during the VA claims process.

You still need to ensure you have medical evidence (medical records) with a current diagnosis as well as documentation of severity of symptoms.

Can the VA Deny a VA Claim With a Nexus letter?

Yes, the VA can deny your VA claim with a Nexus Letter.

It’s important to note that while a Nexus Letter can help strengthen your claim, especially in the absence of evidence in your Service Treatment Records (STRs), it does not guarantee service connection.

Also, keep in mind that you might have done everything right and still got denied due to human error or a mistake, it happens often.  

Or maybe you got a Bad C&P Exam and got denied even though you had a Nexus Letter from a private healthcare provider.

Even if the VA denies your initial claim with a Nexus Letter, a strong Nexus Letter can still be a key piece of evidence to help you win your appeal—whether through a Higher-Level Review (HLR), Supplemental Claim, or Board Appeal.

Can a Bad C&P Exam Outweigh a Nexus Letter?

Yes, a bad C&P exam can lead to a denial even if you have a strong Nexus Letter.

VA-contracted examiners are often viewed as impartial, and their findings may carry more weight in the decision-making process of your claim.

If a veteran receives an unfavorable C&P exam, they can:

• Challenge the C&P exam results with additional evidence, including a rebuttal from a private medical expert.

• Request a new C&P exam with a different examiner.

• File a Higher-Level Review (HLR) to get a second opinion from a new VA claims adjudicator or file a Supplemental Claim with new and relevant evidence not previously considered, including clarifications or rebuttals from the doctor who wrote your Nexus Letter.

How Do You Challenge a VA Denial Even With a Nexus Letter?

If your claim is denied despite having a Nexus Letter, you can:

• Request a Higher-Level Review (HLR): Ask for a senior reviewer to re-evaluate the decision without submitting new evidence.

• File a Supplemental Claim: Submit additional evidence, such as medical opinions, test results, or clarifications from the Nexus Letter provider.

• Appeal to the Board of Veterans’ Appeals (BVA): Start with a records-only Board Appeal, but only after exhausting your HLR and Supplemental Claim options.

Looking for a Nexus Letter to Support 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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