Claims help · Evidence
Getting a Nexus Letter That Holds Up
A medical opinion linking your condition to service can turn a denial into an approval. Here’s how to ask for one, and what it needs to say.
- Who to ask
- What to give them
- Key wording
- Mistakes to avoid
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Who to Ask
Start with a provider who already treats the condition, such as a primary care doctor, specialist, psychologist or psychiatrist. They know your history, which makes the opinion more persuasive. Some veterans use an independent medical examiner when their own provider won’t write one.
What to Give Them
- Your service treatment records and any records of the in-service event
- Your VA decision letter, if you were denied, so they can address the VA’s reasoning
- A short timeline of symptoms from service to now
- For secondary claims, records of the service-connected condition that caused it
The Wording That Matters
The VA standard is whether it’s “at least as likely as not” (a 50% or greater probability) that the condition is related to service. The opinion should say that plainly, state that the records were reviewed, and explain the medical reasoning behind the conclusion.
Mistakes to avoid
- Hedging words like “could,” “may,” or “possibly”
- A conclusion with no explanation
- Ignoring evidence that points the other way
Getting a Nexus Letter: Common Questions
Will my VA doctor write a nexus letter?
Some will and some won’t. If yours won’t, a private provider or independent medical examiner may.
How long should a nexus letter be?
Long enough to show the records were reviewed and to explain the reasoning. A thorough page or two is common; length matters less than reasoning.
Do presumptive conditions need a nexus letter?
Usually not. For presumptive conditions the VA assumes the link if you meet the service requirements.
Can a nexus letter be used after a denial?
Yes. A new, relevant medical opinion is a common piece of evidence in a Supplemental Claim.
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