The nexus, or link between a veteran’s current disability and an in-service event, is often the hardest element of service connection to prove for a VA disability claim. However, without a nexus, a veteran’s claim with the Department of Veteran Affairs (VA) won’t survive.
How does a veteran prove this complicated, yet crucial, element of service connection?
The nexus letter.
In fact, a well-written nexus letter may be the single most important document that a veteran can have for evidence in support of their claim for VA disability benefits. Short on time? Download our Nexus Letter below!
What Is a Nexus Letter?
A nexus letter is a document that a doctor, or other medical professional, prepares for a veteran. It explains that the veteran’s current medical condition is related to their military service.
A veteran is not required to submit a nexus letter in connection with their disability claim, but the nexus letter can sometimes make the difference between an award and a denial on VA disability claims. Also, there is not a specific requirement of when a nexus letter can be submitted.
A veteran can submit a nexus letter with their initial application for benefits, during the development of their claim, or after an adverse C&P Exam. However, it’s a good practice to submit a nexus letter earlier rather than later when claims are being processed.
The nexus letter is especially important in cases where a veteran has not submitted any medical evidence in support of their claim, and then a C&P examiner concludes that there is no connection between the veteran’s disability and military service.
If done correctly, a doctor’s opinion can be very instrumental for a fully-developed VA claim.
What Should a Nexus Letter Include?
Doctor’s opinions, especially in the form of a nexus letter, can be a very valuable tool in disability claims if they are done correctly. Make sure to communicate with the doctor writing the nexus letter about all of the details the letter should include.
A good nexus letter uses specific language, includes specific phrases, and ties the facts together to draw a conclusion about connection to service. Terminology is very important in the nexus letter.
Many doctors are not familiar with veterans law, the VA system, and VA standards; instead, they are familiar with the concept of “medical certainty.” Medical certainty is a much higher standard than the VA requires.
In order to avoid a situation where the doctor applies the wrong standard, make sure the VA terminology is explained to them.
For example, the terms “more likely than not” should be used to express that there is a 50% likelihood that the veteran’s current disability is related to his service. Using other terms may lead the VA to misunderstand the opinion as not supporting service connection.
It is also important to note that a doctor should mention in their letter that they have reviewed the veteran’s entire file and medical records. Failure to do this can result in the VA disregarding the doctor’s opinion.
When choosing a doctor to provide a nexus letter, start with the doctors that are currently treating you, or have recently been treating you. The VA does not require this. But oftentimes, a treating doctor will have a better understanding of your conditions and the history behind them.
Tips for an Effective Nexus Letter
In summary, here are some things that make for a stronger nexus letter. You can view a sample nexus letter below.
Keep The Letter Brief, Yet Detailed
Keep the letter brief, but still complete. Do so by focusing on facts and conclusions. The doctor should describe the symptoms in detail and be clear about the diagnosis. It’s also important to cite medical research that supports the nexus.
Ask The Right Doctor
Use a doctor who is board-certified in the area of health that is at issue.
Make sure the doctor has access to your relevant medical records and service. Have the doctor state in the letter that they had access to, and were able to review, these records.
While not required, using a doctor that has recently examined the veteran can add weight to the nexus letter.
Use VA Language
The doctor’s medical opinion does not have to be absolute. Remember to inform the doctor that they just need to point out whether “it is as least as likely as not” that the current condition was caused by an event during service.
Remember The Proper Formatting
There are a few formatting elements that your nexus letter should have. You’ll want to make sure that the doctor writing your letter uses the proper headers. They should put their name with credentials and contact information at the top of the letter.
An example heading would be:
Dr. Jane Doe, MD
1234 Medical Lane
Boston, MA 02101
They should also include the following information above the first paragraph of the latter:
Date: January 1, 2021
Reference: [Veteran’s Name]
VA File #: XXXXX
Veteran SSN: XXX-XX-XXXX
Sign the letter with your name and credentials as well.
You can download our Nexus letter template here.
Keep in mind that the doctor who agrees to write a nexus letter is a neutral party. As a neutral party, they are supposed to provide an honest medical opinion based on their review of the evidence presented to them. The doctor is not required or obligated, to agree with the veteran when writing their medical nexus opinion.
Nexus Letter Example for VA Benefits
Here is a sample nexus letter to show your medical provider.
January 1, 2021
Reference: John Doe
VA File #: 1234567
Veteran’s SSN: 123-45-6789
To Whom It May Concern,
I am Dr. Mary Medicine. I am a board certified to practice in my specialty of orthopedic surgery. My CV is attached.
I am writing a statement in support of John Doe’s application for disability benefits. John Doe has been a patient at my practice since March 15, 2003. He has a diagnosis of degenerative disc disease.
I have personally reviewed John Doe’s medical history. I have also reviewed the in-service events and incidents, which include the lifting and carrying of heavy military equipment that occured between June of 2001 and January of 2002 in Iraq.
I have examined John Doe often and am familiar with his diagnostic results, including spinal x-rays, CT scans, and MRI tests. I have attached these medical reports.
John Doe does not have a known history of risk factors that may have caused the degenerative disc disease.
Based on my professional experience as an orthopedic surgeon and knowledge of medical literature, it is known that lifting and carrying heavy objects for a prolonged period of time can put pressure on the spine and lead to degenerative disc disease.
It is my professional opinion that it is more likely than not that John Doe’s degenerative disc disease is a direct result of the prolonged lifting and carrying of heavy equipment that occurred during military service.
Signed,
Dr. Mary Medicine, MD
Orthopedic Surgery
(123) 456-7890
123 Medical Office Dr.
Anytown, FL 12345
