How does the nexus letter process work?

How Does the Nexus Letters for Veterans Process Work?

The unfortunate truth about filing for disability benefits with the VA is that many claims are denied. Often, these rejections occur because of the lack of evidence that a particular disability is linked to an in-service event. Nexus letters are documents created by doctors that highlight this link for the claims decision-makers working for the VA. 

So, how does the nexus letter process work? You have options when it comes to the right time to submit these letters, but it is crucial that they include a minimum amount of important information related to your disability, your time in the military, and the connection between the two. Elite Medical Review Associates is here to help you secure nexus letters for veterans.

What is a Nexus Letter?

A nexus letter is a document written by a medical professional and provided to the VA during the course of your disability claim process. These letters establish that you are living with a disability that prevents you from taking part in meaningful employment. They also provide details from your service records regarding events or stressors that occurred during your service. 

The critical part of these letters is the opinion of your doctor that your disability is connected to your service. This connection, known as a nexus, is generally established by the doctor reviewing your records, relying on medical journals, and highlighting the points during your military career that may have led to your health condition. 

Nexus letters are common, and many veterans cite these documents as the reason why their claim was ultimately successful. However, there is no requirement that you submit these letters as part of your disability claim. In fact, the VA will presume that a disability is service-related in some scenarios.

This is known as a presumed service connection. It is only an option when a veteran has a specific disability while other relevant factors are present. This could include having certain types of cancer after being exposed to Agent Orange during the Vietnam War. Many conditions are also presumed to be service-related when it comes to former prisoners of war. 

If you cannot rely on a presumed service connection, you will need to be able to prove that your disability is related to your time in the military. A nexus letter for veterans might be what you need.

What to Include in a Nexus Letter

There are certain things that every nexus letter must do. In order for these documents to be useful in your disability case, they should include the following: 

A Statement

Your nexus letter should start with a clear statement of your claim. This begins with first documenting the details of your disability. Your nexus doctor can use your medical records to highlight how long you have been dealing with these issues while also setting out each of your symptoms. 

The statement should cover more than just your medical history. It should also outline your military service, including any relevant stressors or events to be aware of. These details are pulled from medical and service records, in addition to the forms completed during the application process.

It must also include a statement that the doctor has reviewed the relevant portions of the claims file such that his opinion is fully informed.

Supporting Rationale

It is not enough for your nexus doctor to discuss your disabling condition or your service record—they will need to provide medical science as well. This is typically done by referencing scientific or medical literature, such as journal articles or medical treatises. For example, the doctor could include reference to portions of your medical records that describe your condition or reports from your service that confirm the things you experienced.  He would then discuss those in the context of the medical science.

 Written statements are also frequently helpful throughout this process. While a statement from you may provide context for the VA, VA raters are often looking for “buddy letters” from people you served with. These letters could confirm that the events you believe are responsible for your disability took place.


The links between your disabling condition and events that occurred during your service period are not always crystal clear. Often, your letter will need to provide reference to relevant medical research or scholarly journals that help explain how a service connection is plausible. This research should back up the conclusion or doctor ultimately makes.

Final Conclusion

It is vital that a nexus letter includes a conclusion, but your doctor does not have to say with certainty there is a service connection. Instead, the standard for these letters is that it is as likely as not that your disability stems from an event that occurred during your service.  Doctors must avoid using speculative verbiage like “could be” or “may be.”

One of the worst mistakes a doctor can make is to fail to provide a conclusion at all. However, overselling the evidence can also raise red flags and diminish the weight a letter is given. For example, the VA frowns on finding that a nexus is more likely than not when the evidence does not support this conclusion.

When Can a Nexus Letter be Submitted?

You have flexibility when it comes to the time to submit nexus letters for veterans. It depends on the phase of the case, whether it is a new claim or an appeal. In general, applicants will typically submit these letters along with the initial application, during the claims process, or as part of an appeal following a denial. For appeals, only certain lanes for Board appeals and supplemental claims are amenable to submitting new evidence.  

In general, it is a good idea to submit a nexus letter as early as possible. In many cases, this document is a deciding factor that leads to a favorable outcome. Because of how important it is to establish a link between your disability and your military service, there is no downside to providing this letter as soon as possible. 

Of course, there are practical realities that can delay things. Nexus letters cost money based on the doctor’s time and effort. For some veterans, securing those funds can be difficult. Veterans who attempt to navigate the claims process on their own also might not be aware that these letters are an option, much less a critical part of many cases. Ultimately, some veterans choose to submit a letter while the claim is active but before a decision is made.

Roughly 30 percent of all disability claims are initially denied. This negative outcome is a common catalyst for a veteran to seek out a medical professional who can prepare a letter on their behalf. It should come as no surprise then that the inclusion of a nexus letter is a common strategy on appeal. 

Some veterans will wait until later in the claims process without being denied first. If the VA issues an adverse C&P exam report, it is a common strategy to respond with a nexus letter that supports your case.

Finding a Nexus Doctor

Before you rely on these letters to bolster your case for compensation, you will need to find a nexus doctor. This can be more challenging than it sounds. While any physician licensed in the United States could write a letter on your behalf, most are unlikely to do so. 

Some doctors do not have the time or interest in providing you with a letter for your VA disability claim. Others might be open to assisting you but lack an understanding of the process. What’s more, many of the doctors who focus a part of their practice on assisting veterans do not advertise these services. 

There are consultants who can help you find the right medical expert for your case, but these companies are not the same. Some might offer ambiguous support without any guarantee that a doctor will review your records. Others might rely on predatory pricing to take advantage of you. Let Elite Medical Review Associates assist with securing a nexus doctor for your case. 

Other Parties Who Could Write a Nexus Letter for Veterans

While many people rely on physicians to provide their nexus letter, it is worth noting that other individuals might also be able to help. Reaching beyond a family physician or a specialist might make it easier to secure a letter as well.

Nurse practitioners and physician assistants are typically able to write a letter on your behalf. Each of these professions requires advanced medical training that allows for the limited ability to see patients independently. Either one of these options might be available to you. 

There are also healthcare providers who are not eligible to write your VA nexus letter. For example, acupuncturists cannot be used for this purpose. Elite Medical Review Associates can help you connect with the right medical expert for your disability case.

Let Elite Medical Review Associates Help With Nexus Letters for Veterans

If you are struggling to prove a connection between your disability and the time you spend in the military, a nexus letter might help. Securing these documents can be challenging on your own, but Elite Medical Review Associates is here to help. Contact us as soon as possible to discuss your options with our team. 

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