If you’re a veteran seeking disability benefits from the United States Department of Veterans Affairs (VA), you may need to prove that your disability or condition is related to your military service. To prove a direct service connection for a disease, injury, or condition, you must show that an in-service incident or event directly caused the medical condition you’re currently suffering from. Making this connection isn’t always easy to do, and getting proof and solid evidence to support your claim can be difficult.

That is why a nexus letter from a medical professional is critical to your disability claim. “Nexus” is defined as a tie, bond, link, or connection between two things. In this letter, a medical professional needs to provide evidence that your disability is linked or connected to an event during your military service.

Why a Nexus Letter Is So Important

When a VA ratings specialist reads your claim for disability benefits, he is looking for irrefutable evidence that your condition meets certain criteria—percentages, levels, or similarities to other conditions. This criteria is used to help determine if you should Medical Professional Writing a Letterreceive compensation. If there is any doubt in his mind about your disability, its severity, or its connection to your service, your claim may be denied.

When you file a disability claim, your doctor doesn’t have to send a nexus letter; however, it can make a big difference in being awarded compensation. Your doctor can submit this letter with your initial application, during the claims process, or later. But it’s a good idea to submit the letter as early as possible. 

Details of a Nexus Letter

A nexus letter can be a powerful tool for helping a veteran receive a favorable determination about his claim. Typically, the VA recognizes that the doctor who wrote the letter is an expert—more experienced, better skilled, and has probably spent more time discussing your condition and examining you than anyone else. Very often, that expert opinion is the determining factor when a veteran wins his case. Here is a brief look at some of the main points that should be made in a nexus letter:

  • The letter should be complete and detailed, but state only the facts.
  • The doctor should write the letter on his own letterhead.
  • The doctor who writes the letter must be an expert—a board certified medical professional whose expertise is in the specific health issue cited in the claim.
  • The medical professional who signs the nexus letter must state that he has reviewed all relevant and available medical records. The letter is worth very little if this cannot be reasonably verified.
  • The doctor does not have to draw conclusions in the letter. He’s not required to say that the military event or incident specifically caused the condition. Instead, he should say that the event “might have” caused the condition or is “likely” to have caused it.

Here is the most advantageous language the expert can use:

  • “It is more likely than not” (a probability greater than 50 percent) that the illness or disability started or was aggravated during service.
  • “It is at least as likely as not” (probability of 50 percent) that the illness or disability started or was aggravated during service.
  • “It is less likely than not” (probability less than 50 percent) that the illness or disability started or was aggravated during service.

It’s important to note that additional weight is given to the doctor who writes the nexus letter if he has recently examined the veteran making the claim.

Why Doctors Are Reluctant to Write a Nexus Letter

Very often, both VA and civilian doctors are hesitant to write a nexus letter. In some cases, the medical professional may be concerned about the potential legal ramifications of this type of letter and want to avoid them. In other cases, the doctor may be too busy to write a letter or not be clear about the best language or terminology to use. If you can’t get your own doctor to write a nexus letter, you may need to hire a medical professional who is a specialist in Independent Medical Examinations (IMEs). Most of these specialists have good reputations, are impartial, and know the necessary language needed for these letters. These evaluations are expensive and often times your attorney can locate the expert and advance the costs of these examinations if they are necessary.This is the type of development that a private attorney will undertake.

If you’re a veteran who believes your condition was caused by your military service and you need a nexus letter, contact us at 402-933-5405 to discuss your situation. We can help you through the claims process and help you appeal a denial.


Sean D. Cuddigan
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SSA and VA Disability Attorney in Omaha, Nebraska