Nexus letter


         The Nexus Letter

There are certain important things in this world that we only get one shot at. Such is the Nexus letter in a veteran’s service-connected disability claim with the Department of Veterans Affairs. Although only one Nexus letter is required, it is advisable to seek the overwhelming number of three individual and concurring Nexus letters if possible. The Nexus letter may require a lot of effort on the part of the veteran, but the return is indispensable.

Generally, according to the law, three elements are necessary and therefore required to obtain a favorable decision by a veteran for service-connected benefits.

#1- An event in service that could have caused or aggravated a disease or condition

#2- A present day diagnosis of the existence of the same disease or condition

#3- A medical opinion linking number 1 with number 2

The required medical opinion is called a Nexus letter. The letter must be written specifically for the individual and explicit to that individual’s claim. It is important that the opinion be expressed as a degree of likelihood. The degrees of likelihood, arranged in ascending order from the lesser to the greater are as follows, “not likely”, “at least as likely as not”, “more than likely”, “and highly likely”.

In the case of “at least as likely as not”, the veteran always receives the benefit of doubt and therefore the outcome is considered a favorable opinion. The doctor, or expert, does not have to use absolutes or conclusions in the statement. Opinions are gleaned by a review of the pertinent records and facts. A professional opinion can then be rendered based upon the record, the medical history, the facts, and the education and/or experience of the author of the letter.

Most denied veterans’ claims failed because of the lack of a Nexus letter altogether or the lack of a properly written Nexus letter.

A proper Nexus letter must be as brief as possible while stating the facts and must include the following:

“After a review of the veterans pertinent records” – (use medical and any service records furnished by the veteran to show the event in service)

“It is my professional opinion that it is at least as likely as not” – (choose and insert the proper degree of likelihood, see above choices)

The author must offer a rationale as to the opinion in the statement – (e.g.,” It is well known in medical journals”)

The author must provide credentials, especially VA titles or specialties – (e.g., Oncologist, Hematologist, Orthopedic Surgeon, Environmental Clinician, etc.)

Please understand that the VA often uses credentials to assign probative value to the nexus letter.

Example of a Nexus Letter

DATE ____________

Reference: (Veteran’s name) ____________

SS# ____________________         VA File #____________________

To Whom It May Concern,

I am Dr. ____________. I am board certified to practice in my specialty. My credentials are included. I have been asked to write a statement in support of the afore mentioned veterans claim.

I have personally reviewed his medical history. (Name the Documents) I have also reviewed and have noted the circumstances and events of his military service in the years ____________ (Event or Events claimed as the cause of the condition) while he served during his military service. (List dates of service)

Mr. ___________ is a patient under my care since (enter Date). His diagnosis is _____________ (Name the Condition).

I am familiar with his history and have examined Mr.____________ often while he has been under my care. (Specify Lab Work, X-rays, Etc.)

Mr.____________ has no other known risk factors that may have precipitated his current condition.

After a review of the pertinent records it is my professional opinion that it is at least as likely as not that Mr. ____________’s condition is a direct result of his (Event) as due to his military service. (Choose the degree of likelihood with which you can concur – “at least as likely as not”, “more than likely”, or “highly likely”)

In my personal experience and in the medical literature it is known (Give a rationale).


Dr. ____________
(List credentials and contact information)

Please understand that the VA often uses credentials to assign probative value to the nexus letter.
While the nexus letter must be brief as possible it should be as detailed and complete as the circumstances dictate.

Authored by James M. Cripps – 2013 USVA