The Nexus Letter - An Explanation and Example

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.

There are physicians available who will perform records reviews and/or Independent Medical Examinations and provide opinions. Often these doctors do a very good job of providing a nexus letter if the veteran isn't otherwise able to obtain one.

The charge for such a letter from an independent physician can vary depending on the extent of the services. The veteran must pay that fee in advance with no guarantee that any award will be won. The Independent Medical Examining doctor does not treat or prescribe medications but only provides services of review and report.

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;

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

A: 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) GOOD

2. “more likely than not” (greater than 50%) GOOD

3. “at least as likely as not” (equal to or greater than 50%) GOOD

4. “not at least as likely as not” (less than 50%) NOT GOOD

5. “is not due to” (0%) NOT GOOD

That key phrase of “more likely than not” or “at least as likely as not” is right where the DRO wants it.

The only thing missing from this letter is an often used statement to point out that there are no other known or apparent causes for the current condition. That might read like; "There is no known history of the veteran's family having this condition..."or" The veteran has no other known history that would cause or contribute to this condition...".

I only include that statement when the cause of the condition is less than apparent. I might use that to show that a cancer was more likely than not caused by exposure to Agent Orange and that the veteran had no family history or exposure to other carcinogenic chemicals that may be seen as a possible cause for the current condition. In this case there were 2 documented traumatic events that were the likely cause of the injury making any reference to other possible causes unnecessary.

Remember, just because your Doctor writes a letter stating you have a medical condition that WILL NOT be enough to award you a disability benefit. Your Doctor must write the condition MUST BE (1) linked, (2) caused / contributed or (3) aggravated by your military service. If you have a letter without this information your claim WILL MOST LIKELY be denied. We cannot stress this enough. Also, just because you are going to the VA for treatment for your condition that does not automatically qualify you for compensation. You will still need the "Nexus" letter and file a claim for compensation.

Medical Nexus Example

Medical Opinion for Direct Service Connection:

• Provide a current diagnosis for injury/illness that you believe is the result of honorable service.

• Ask a doctor to review your service records and ask if the injury / disease / illness could be linked to service with a medical nexus.

Example of direct service connection:

I have reviewed the Veteran's Service Medical Records and their current treatment records(s) and in my opinion "it is more likely than not" that the Veteran's (diagnosis) is related to their military duty. I base my opinion on this because (the doctor will write sound medical opinion).

_________________________________________________________

Medical Opinion for Secondary Service Connection:

• Provide a current diagnosis for the injury/disease/illness that you believe is secondary/proximate to your service connected condition.

• Get a doctor to link this injury/disease/illness to your service-connected condition with a medical nexus.

Example:

I have reviewed the Veteran's current treatment records(s) and in my opinion "it is more likely than not" that the Veteran's (diagnosis) is secondary and/or proximate to the Veteran's service-connected (condition). I base my opinion on this because (the doctor will write sound medical opinion).

Is there a VA form for nexus/medical opinions?

The VA is all about forms, so yes.

This states it is for internal use but is -when properly filled out by a medical provider- valid medical evidence.