6 Tips for Writing a Nexus Letter

A great VA nexus letter can be the key to getting your VA disability claim approved, so it’s important to submit one that’s clear and informative. There are a few best practices to consider when preparing a nexus letter for your disability claim.

  1. Choose the Right Doctor
  2. Provide the Doctor With All Your Records
  3. Write the Nexus Letter on the Doctor’s Letterhead
  4. Use VA Language
  5. Use the Correct Formatting
  6. Be Concise

Nexus letters are written by medical experts and show the link (or nexus) between your disability and your military service. You want to get your disability compensation claim approved the first time so you can begin receiving the benefits you deserve. A good nexus letter can help you do that.

What Is a Nexus Letter and Why Is It Important?

A nexus letter connects a veteran’s medical condition to their time on active duty. It is sometimes referred to as an Independent Medical Opinion or IMO letter. It is written by a medical expert familiar with your illness or injury who has reviewed your medical history. In turn, they state whether it is likely that your military service caused or aggravated your condition. A nexus letter can give a claim the credibility it needs to be approved by VA raters.

You can submit a nexus letter at any time in the claims process. Since the nexus letter can help get your claim approved the first time, it’s best to submit it with your initial VA disability claim. However, you can also submit it with an appeal or in response to an unfavorable C&P exam.

Why is a nexus letter important? For a disability claim to be approved, it must show three things:

  1. A medical diagnosis of a condition
  2. Medical nexus evidence
  3. Current symptoms and how they affect daily life

Medical nexus, or the link between your disability and military service, can be proved by the medical evidence you submit. If your medical record alone doesn’t provide enough proof, a medical nexus letter is needed.

If your disability case is complex and you lack medical records to back up your claim, a nexus letter is even more critical. For exposure illnesses such as agent orange or burn pit exposure, the nexus opinion of a medical expert can help a claim get approved. Another example is when trying to link a secondary disability. A written account from a doctor who can connect the two may be necessary.

6 Tips for Writing a Great VA Nexus Letter

The key to linking your current disability to your military service to receive disability compensation is providing a solid nexus letter. Here are some tips for writing a great nexus letter that gets results.

Choose the Right Doctor

When choosing a doctor to write your nexus letter, you should select one familiar with your current disability. Ideally, a specialist such as a cardiologist, orthopedic surgeon, or another specialist appropriate to your condition should write the nexus letter for you. Avoid asking a VA doctor or a doctor contracted by the VA for a nexus letter.

Another option is to consult a medical professional who specializes in veteran disability to write your nexus letter. Select a doctor who has experience writing nexus letters and has favorable reviews if you choose this route. You can also ask to see examples of past nexus letters they have written.

Provide the Doctor With All Your Records

To write a comprehensive nexus letter, your doctor will need access to all medical treatment notes, lab notes, test results, or military files relating to your disability. It is also helpful to provide buddy letters or testimonials that you may have. It is best to gather all your medical and personnel records ahead of time and present them all right away instead of adding new documents as you find them.

Your doctor needs a complete picture of your health before and after the disability to write a convincing and detailed statement. The more details provided, the more value the nexus letter will add to your disability claim.

Write the Nexus Letter on Doctor’s Letterhead

For your nexus letter to carry the most weight, it needs to be written by a licensed medical expert in the appropriate medical specialty. What better way to establish credibility upfront than to write the letter on the doctor’s letterhead?

The letterhead shows VA raters right away that the medical opinion they are about to read is from an experienced and licensed medical professional, and there is no need to scan to the bottom to see who the author is.

Use VA Language

Who reads nexus letters? VA claims officials do, and that’s why your doctor must use VA language when stating the medical opinion regarding the likelihood that your disability is service-connected. The VA uses the following terms to describe levels of certainty of service connection:

  • “is due to” means 100% sure
  • “more likely than not” means more than a 50% chance
  • “at least as likely as not” means 50% or more chance
  • “not at least as likely as not” means a less than 50% chance
  • “is not due to” means there is no chance

If you think that you need to prove that your disability stems from your military service without a shadow of a doubt, that’s not true. For a VA disability claim to be approved, the evidence needs to show that it is equally as likely as it is not likely that your disability is a result of your military service.

The above criteria are what VA officials use to decide claims, so they want to see this exact phrasing used in any medical opinion that accompanies your claim. Be sure that your doctor understands these levels of certainty when assessing your case and uses the appropriate language in your nexus letter.

Use the Correct Formatting

You may be wondering, “what should a nexus letter include?” There’s a basic format for nexus letters, so you can be sure you’ve included all the required information. Your nexus letter should follow this format:

  • Credentials
  • Reference of thorough record review
  • The medical opinion expressed in VA language
  • The medical rationale with supporting medical literature and case law

The letter begins with credentials upfront when written on the doctor’s letterhead. Next, the doctor should state that a complete review of medical records was accomplished and list the specific instances that link symptoms to service events. The medical opinion follows, again, making sure the exact VA language is used when assigning probability. As long as the facts support it, you’ll want the medical opinion to be “at least as likely as not.”

Wrap up the letter by giving the reasons to support the medical decision. Here the doctor will cite any medical literature or case law from similar instances that support this medical opinion they’ve reached. Approved cases with similar circumstances and medical studies that link conditions to military service add convincing weight to the nexus letter.

You may want to give your doctor a sample nexus letter as a template to follow. Sample letters are beneficial for doctors who are not familiar with the VA disability claims process. But it can also be a valuable tool for experienced doctors to follow, just to be sure the letter is formatted correctly and includes all the required components.

Be Concise

As of December 2021, nearly 630,000 pending claims are waiting to be reviewed and decided on by the VA. Claims officials have lots of paperwork to read through and need to be as efficient as possible. For that reason, you’ll want your nexus letter to be concise and to the point. The nexus letter should be evidence-based and detailed but not lengthy. Short and sweet is the best rule of thumb.

Do You Need a Nexus Letter?

Does every claim need to have a nexus letter? Probably not. If your disability was diagnosed while on active duty and you have medical documentation supporting your diagnosis, you probably don’t need a nexus letter.

Suppose your medical condition was diagnosed after you left military service and have no medical documents showing symptoms of your condition while still on active duty. In that case, you should get a nexus letter to show the link to the service connection.

Also, when filing an appeal on a denied disability claim, you should include a nexus letter to provide a more compelling case to get your appeal approved. Submitting a claim for a secondary disability is another time when a nexus letter is helpful to show the connection. For example, when proving that sleep apnea is a secondary disability to PTSD.

How Much Does a Nexus Letter Cost?

The cost of a nexus letter can vary depending on the experience and credentials of the doctor writing it. The average cost is $1,500, so it is essential to research and select a reputable doctor. Some organizations will write the letter for free and then charge a flat or percentage fee when the disability compensation claim is approved.

A separate letter is required for each condition, so getting multiple nexus letters can be costly. If you’ve determined that a nexus letter can best help your claim get approved, it can be a worthwhile investment.

Nexus Letter for Your Disability Claim

A nexus letter shows the link (or nexus) between your disability and your military service, which is needed to get your disability claim approved for VA disability benefits. A nexus letter is written by a medical professional who will give their medical opinion on the probability that your current medical condition was caused or aggravated by your military service after a complete review of your records.

For the VA to approve your claim, you must prove that it “as at least as likely as not” that your disability is service-connected. Using this specific language is necessary as this is the standard that the VA uses to determine service connection.

Likewise, it is essential to follow a clear format when writing the letter. The four parts of a nexus letter are credentials, reference of medical record review, medical opinion, and medical rationale. Letters should be evidence-based and concise, along with citations of medical literature and case law that backs the doctor’s opinion.

Not every veteran needs to include a nexus letter with their disability claim. Adding a nexus letter isn’t necessary for those with a disability that is clearly from service with a diagnosis and treatment during their time on active duty. But for veterans whose disability appeared after military discharge or who lack adequate medical records, a nexus letter can provide the missing link between service and their current medical condition needed to approve their claim.