You’ve served your country, and now you’re navigating the complex world of VA disability claims. One of the most important things the VA wants to see is a connection—or nexus—between your condition/disability and your military service. A nexus letter from a qualified doctor is one of the most powerful ways to establish this connection.
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Do I Need a Nexus Letter to Show a Service Connection?
Not everyone requires a nexus letter. For example, you probably don’t need one if you have medical evidence that your condition was diagnosed while you were in the service.
Another reason you may not need a nexus letter is if you are claiming a presumptive condition. A presumptive condition is one that the VA automatically presumes is connected to your military service. For example, if you were exposed to Agent Orange and later developed lung cancer, you will not need a nexus letter because lung cancer is on the presumptive conditions list for Agent Orange. You will get an automatic green light for a service connection.
Avoid These 4 Mistakes
If you do need a nexus letter, you can start by finding a doctor to write it for you. But even with a good doctor on your side, you could fall prey to errors that could lead to frustrating denials for your VA rating increase. If you are seeking a nexus letter to strengthen your VA claim, avoid these common pitfalls.
1. DON’T Go to Your Doctor Unprepared
Your doctor may or may not have written a nexus letter for a veteran in the past. Even some VA doctors are unsure about how to write these letters. Don’t assume your doctor is a nexus letter expert; go prepared to explain to them what the VA needs to see. Consider taking your doctor a sample of a nexus letter that has been used successfully by other veterans. This will allow your doctor to see what kind of information they need to share and how to format it.
2. DON’T Submit a Letter without “At Least as Likely as Not” Verbiage
The VA has very specific requirements for your nexus letter; they need to see that it is “at least as likely as not” or “more likely than not” that your injury or illness is related to your time in service. Even phrases like “it is most likely” that your condition is service-connected won’t cut it.
Your letter needs very specific language showing that it is 50% or more likely that your condition is connected to your military service. Otherwise, your claim will likely get denied—no matter how bad your health condition or how compelling your other evidence is. Tell your doctor about the importance of the “at least as likely as not” phrase. You don’t want a few incorrect words to tank your VA claim!
3. DON’T Overlook the Power of Peer-Reviewed Studies
The more evidence you can present to support your claim, the better. And knowing that your doctor may not have a lot of time to dig up evidence, you can do your part to make his or her job easier.
Let’s say that you did a lot of ruck runs in the military and now you have knee pain and arthritis. Your doctor may not know a lot about the link between these load-bearing runs and your knee pain, so you could take them a peer-reviewed study showing the link between the two.
Similarly, if you are claiming sleep apnea as a condition secondary to your military-induced tinnitus, you could present your doctor with a peer-reviewed study showing the link between these two conditions. Your doctor can then include the study when they write your nexus letter for sleep apnea secondary to tinnitus.
We’re not recommending that you approach your doctor’s appointment like a know-it-all, but do offer resources to make your provider’s job easier.
4. DON’T Choose the Wrong Type of Doctor
While any licensed medical professional can write your nexus letter, the VA will place greater trust in the opinions of doctors—particularly doctors who practice in a relevant specialty. For example, if you have PTSD, the VA will likely give greater credence to a letter from a psychiatrist than from a family doctor or nurse practitioner.
5. DON’T Choose an Out-of-state Doctor Who Isn’t Familiar with Your Case
There are companies out there that will sell you a nexus letter, but the VA usually knows who they are. If they see that you have a letter from one of these companies, they will likely view your case with skepticism—especially if the company’s doctors do not live in your state.
The VA wants to know that you have been examined by the doctor who is writing your letter and that they are familiar with your treatment history. An impersonal letter from an out-of-state doctor won’t convey this familiarity and background knowledge. The best letter will likely come from your personal doctor with some guidance from you on how to write a persuasive nexus letter (if they haven’t written one before).
6. DON’T Let a VA Doctor Tell You They Can’t Write Your Letter
If you are assigned to a VA doctor, they will willingly write a compelling nexus letter for you, right? Wrong!
We have heard from many veterans who say that VA doctors (or contracted VA doctors) either don’t know how to write one of these letters or don’t feel comfortable doing so (fearing a conflict of interest).
If this is your experience, point your VA doctor to VA Directive 1134, section 4: “Except when specifically prohibited, it is VHA policy that providers, when requested, must assist patients in completion of VA and non-VA medical forms and provide medical statements with respect to the patient’s medical condition and functionality.”
So writing nexus letters isn’t just a nice thing for VA doctors to do. These doctors are actually required to write medical statements on your behalf.
Don’t go in like a sledgehammer and demand that your doctor helps you, but do respectfully show them the policy and request their help.
Need more help getting a nexus letter to support your VA claim? Contact VA Claims Academy. We can provide you with plug-and-play templates to help your doctor write a nexus letter in the language that the VA wants to see. It will make things easier for your doctor and increase the chances that you get the VA rating you deserve.