The Veteran's Spouse


The Nexus Letter
To show that there exists a connection
between your documented service event
and your condition today

















































































 
You file for service connected disability compensation, you have a C & P exam and about a year or two later you have a denial letter. The VA tells you that although you had complaints during your service that your condition today is new and unrelated to those old problems.

Now what?

The nexus letter may be the key to winning the appeal. Nexus is defined as "the means of connection between things linked in series".

The task you face now is to seek an expert physician who will review your complete medical records and write a letter stating that it it his or her opinion that your injury (condition) today is related to the military service.

The nexus letter should follow a similar format to all letters that you use to communicate to VA. It may be addressed directly to you or in a "To Whom It May Concern" style. If the physician is willing to provide you with a current curriculum vitae (a resume) that will support the physician's expertise.

The nexus letter should follow the standard business format we always use when writing to the VA. This template below may be used as a beginning for your letter.

A well written nexus statement (or nexus letter) may be the single most important document that you will have in evidence to support your claim of a VA disability benefit.

Your nexus letter is the chain that connects one event to the next.








Getting a nexus letter into your claim isn't a requirement for every claim. Claims that are based on presumptive conditions and claims where the evidence is clear and unmistakable usually don't need such an elaborate document.

When the nexus letter is necessary, there is nothing else that will replace it. If you take the time to read this carefully and get your nexus letter done right the first time, you may save yourself years of appeals.

Nobody will do this for you. Most people, including doctors, don't understand how important it is to use precise language and phrases. You must do it yourself and you must supervise every word of the statement.

Your VA doctor may write a statement that supports your claim.  Click this link to view the VA document that instructs providers on how they may write statements to support your claim. 

To win an award of a disability benefit, you must meet 3 criteria; You have to show eligibility by your military service, you must have a diagnosis of a condition and you must be able to provide evidence that the diagnosed condition had its origin during the time of your military service, or if the condition was preexisting, that it was aggravated by military service.

In many cases, the connection of an event that happened while you were on active duty to a diagnosed condition today may be tenuous at best.  The language in the example above is specific. Any language less specific may not meet the standard that VA will require.







Any physician who is qualified to write such a letter on your behalf may do so. While it is commonly believed that VA physicians aren't allowed to write such letters, that isn't true. VA physicians, as with many civilian physicians, simply don't like to write such letters as they are not skilled at the task, may not have the tools to write the letter at hand and they are often so busy caring for a heavy load of patients this is seen as work that isn't a priority.

It is perfectly acceptable for the veteran to write the letter on behalf of the physician and then ask the physician to sign it. In any setting, whether VA or civilian, the veteran is advised that he or she should not ask a nurse or clerk to perform the task of obtaining a signature for them.

These ancillary members of the care team often see themselves as "gatekeepers" to guard and protect the physician from tasks that will only take up more valuable time.

They may believe that "rules" or "law" won't allow the physician to sign such a document and the veteran may be refused access to the doctor. It's best to make a routine appointment, wait until the veteran is face to face with the M.D. and ask that provider directly.

Most physicians will sign such a letter if it is brief, to the point and factual. When writing a nexus letter great care must be given to recording only facts and the doctor's conclusions.

To win an award of a disability benefit, you must meet 3 criteria; You have to show eligibility by your military service, you must have a diagnosis of a condition and you must be able to provide evidence that the diagnosed condition had its origin during the time of your military service, or if the condition was preexisting, that it was aggravated by military service.

In many cases, the connection of an event that happened while you were on active duty to a diagnosed condition today may be tenuous at best.
  • A nexus letter must be specific
  • The provider must include the exact phrase "more likely than not"
  • The provider who writes the letter must be an expert (as in an M.D. or D.O.) and preferably be board certified in the specialty of the condition that is the subject of the nexus letter.






The importance of the nexus letter can't be overstated. In many situations the nexus letter from an expert is the only evidence that will tip the scales in favor of the veteran.


In the C & P Service Clinicians Guide instructions are given to the examiner as to the exact phrasing that should be used, as follows here:

1.16 How do I give an opinion for nexus (relationship to a military incident)? 

When asked to give an opinion as to whether a condition is related to a specific incident during military service, the opinion should be expressed as follows: 

  1. “is due to” (100% sure)
  2. “more likely than not” (greater than 50%) 
  3. “at least as likely as not” (equal to or greater than 50%)
  4. “not at least as likely as not” (less than 50%) 
  5. “is not due to” (0%) 









The importance of using # 1, 2, or 3 is apparent when we look at a recent letter that was used in an attempt to seek an increase in an existing benefit.

Unless your nexus letter contains the phrase "more likely than not" it may not help you.

The regulation that sits at the heart of all this as well as the other points we've covered regarding your nexus letter:

Title 38: Pensions, Bonuses, and Veterans' Relief PART 3—ADJUDICATION

Subpart A—Pension, Compensation, and Dependency and Indemnity Compensation Ratings and Evaluations; Service Connection
§ 3.303 Principles relating to service connection.

(a) General. Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. This may be accomplished by affirmatively showing inception or aggravation during service or through the application of statutory presumptions.

Each disabling condition shown by a veteran's service records, or for which he seeks a service connection must be considered on the basis of the places, types and circumstances of his service as shown by service records, the official history of each organization in which he served, his medical records and all pertinent medical and lay evidence. Determinations as to service connection will be based on review of the entire evidence of record, with due consideration to the policy of the Department of Veterans Affairs to administer the law under a broad and liberal interpretation consistent with the facts in each individual case.

In plain language that regulation means that the VBA must consider all the evidence you've submitted. That includes all of your military service and the conditions under which you served, where you served, your current condition, and all medical and lay evidence. For the discussion today, we'll assume that your claim was well documented as to the nature of your service, when and where you served and your health then and now.

It's up to you to obtain such a letter. Nobody cares about your claim the way you do.







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