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Veterans Law

Will VA Doctors Write Nexus Letters?

November 2, 2020

In order for any VA disability claim for direct service connection to be successful, three main elements must be present: (1) a current, diagnosed condition; (2) an in-service event, injury, or illness; and (3) a medical nexus linking the current, diagnosed condition to the in-service event, injury, or illness; often through nexus letters.

Providing a medical nexus is often the most difficult part of this process, as it ties a veteran’s claim for service connection together.  Sometimes, VA will schedule veterans for a Compensation & Pension (C&P) examination in order for a VA examiner to determine if there is a link between the veteran’s condition and their military service.  However, a veteran can fulfill this requirement independently by having medical professionals write nexus letters in support of their claim.

What Are Nexus Letters?

Generally speaking, a nexus letter is a document prepared for a veteran by a medical professional that explicitly connects an in-service event to the current condition for which a veteran is seeking service-connected compensation.  Nexus letters can be submitted with a veteran’s initial claim, during claim development, or during the appeals process.

Importantly, nexus letters can also be helpful following negative C&P examinations in which VA examiners conclude that there is no evidence between a veteran’s claimed condition and their military service.  As mentioned above, veterans can ask their private physicians or independent medical examiners to write a VA nexus letter for their claim, but it should be noted that not all nexus letters will be given the same weight or probative value by VA.

How to Write Strong Nexus Letters

When requesting a nexus letter from a non-VA doctor, veterans should be sure that they are aware of the information necessary to include.  A strong nexus letter should:

  • Be written by a licensed professional in the appropriate medical or clinical field
  • Be based on the veteran’s service medical and personnel records
  • Be based on the veteran’s medical history before, and following service
  • Address whether it is “at least as likely as not” that the veteran’s disability was incurred in or caused by service
  • Provide supporting rationale for the conclusion, or in other words, the medical professional “shows their work” by elaborating on how they reached their determination
  • Be brief, factual, and evidence-based

Using the language “at least as likely as not” is especially important as it represents VA’s standard of proof as it pertains to establishing service connection.  Unlike the standard of proof in criminal cases, veterans do not have to show “beyond a reasonable doubt” that their disability was caused by service.  Rather, veterans must show that it is “at least as likely as not” caused by their service, meaning there is at least a 50 percent chance that the disability was incurred in or caused by military service.

An unfavorable nexus letter would state it is “less likely than not” that the veteran’s condition is due to service.  In this case, it means that VA, or a non-VA doctor, found that it is less than 50 percent likely that the veteran’s condition is linked to their time in service.  Therefore, it is very important for veterans to make sure nexus letters use this language as it is what VA looks for when adjudicating claims for service connection.

Reviewing Medical Records for Nexus Letters

The medical professional writing a nexus letter should review the veteran’s entire VA claims file.  If a doctor does not review all of the evidence relevant to a veteran’s claim, VA may dismiss the doctor’s nexus opinion.  A strong nexus letter will use the veteran’s records to address any inconsistencies regarding their condition.  The medical professional can also point to specific records in the claims file to support their opinion that the veteran’s condition is at least as likely as not due to service.

Providing Credentials and Job Title

When submitting a nexus letter from a non-VA doctor, veterans should also be sure that the provider includes a copy of their C.V. (i.e., curriculum vitae) and resume.  Doing so will ensure that VA is aware of the doctor’s credentials, job title, and competency to opine on a veteran’s condition.  Furthermore, it also establishes the medical provider’s credibility to provide an opinion.

Finding Non-VA Doctors to Write Nexus Letters

Again, many veterans elect to have non-VA doctors write a nexus letter in support of their claims.  To find a non-VA doctor to write a nexus letter, veterans may have to go through a thorough search process.  Veterans should start by searching online for competent and qualified doctors who have experience in writing nexus letters.  Importantly, veterans can either search specific names of doctors who they are already aware of, or they can search more generally for “VA nexus letter doctors.”  In some cases, the location of the doctor will matter as veterans may have to attend an in-person examination.

Once veterans have found a few options online, they should research each doctor and obtain background information.  For example, veterans should request to review one of the doctor’s previous VA nexus letters to ensure that they include all of the necessary details and information required for a favorable finding.  Furthermore, veterans should check on reviews from previous clients or veterans who worked with the doctor in obtaining a nexus letter.  If the previous veterans found the doctor’s nexus letter useful, that may give the veteran confidence to move forward with the process.

Can VA and VA-Contracted Doctors Write Nexus Letters?

Importantly, VA and VA-contracted doctors cannot write nexus letters in support of veterans’ claims for direct service connection.  VA and VA-contracted doctors will likely provide a nexus opinion when completing a C&P examination with a veteran; however, they will not write a nexus letter or provide any opinions outside of that context.

Since VA-contracted medical providers are considered to be hired in the service of VA, they are not appropriate medical experts for the purposes of writing nexus letters.  Instead, veterans must find a private, non-VA doctor to complete the nexus letter as described above.

Nexus Letter Cost

As of 2020, the average cost for a nexus letter is around $1,500; however, nexus letters can cost more or less depending on the provider.  There are some doctors and companies who offer nexus letter services for free up-front, but later charge the veteran a certain percentage or price when the veteran receives an award.  If working with an accredited attorney, veterans may not have to pay for the cost of a nexus letter if their claim is unsuccessful (i.e., they do not receive a monetary award).