What Is a Nexus Letter?

In this post, we’ll explain exactly what a nexus letter is, discuss how it can help you establish service connection, and cover important details about how these letters function within the VA system.

What is a nexus letter? 

A nexus letter is essentially a medical opinion written by a qualified healthcare professional. It connects an injury, illness, or condition you have now to an event, injury, or illness that happened during your military service. Think of it as a bridge linking your current health issue back to your time in the service.

A strong nexus letter usually includes:

• A review of your relevant medical history and service records.
• A clear statement that the medical professional has reviewed these records.
• An opinion linking your current condition to your military service (using specific phrases like “is at least as likely as not,” “more likely than not,” or “is caused by or a result of”).
• Medical rationale explaining how the in-service event caused or aggravated the current condition.
• The professional’s credentials showing their expertise in the relevant medical field.

Why is a nexus letter important? 

For the VA to grant service connection for a disability, they generally need three things:

1. A current diagnosis of a disability.
2. Evidence of an event, injury, or illness during your military service.
3. A medical link, or “nexus,” connecting the first two.

While not always required, a well-written nexus letter from a qualified medical expert can provide the clear, evidence-based connection the VA needs to see. It translates complex medical information into a direct opinion about service connection, significantly strengthening your claim, especially if the connection isn’t immediately obvious or if your service medical records are limited.

Is a nexus letter required for all VA claims?

No, a nexus letter isn’t strictly required for every single VA claim. Sometimes, the connection between your service and your current condition is very clear (like a combat wound resulting in an amputation) or legally presumed (like certain conditions associated with Agent Orange exposure for Vietnam veterans).

However, for many conditions, especially those that develop years after service or secondary conditions (caused by an already service-connected condition), a nexus letter becomes incredibly helpful, and often crucial, for establishing that necessary link. 

If the VA determines they need more information to establish a link, they might schedule you for a Compensation & Pension (C&P) exam, where a VA-contracted examiner provides a medical opinion. But submitting your own strong nexus letter upfront can sometimes preempt the need for a C&P exam or provide valuable evidence for the VA rater to consider alongside any C&P results.

Can I write my own VA nexus letter? 

No, you cannot write your own official nexus letter. A nexus letter must come from a qualified, licensed medical professional who can provide an expert medical opinion. The VA needs to see that a medical expert has reviewed your records and believes, based on medical principles, that your condition is linked to your service.

While you can’t write the letter yourself, you can look up “nexus letter examples” online to understand their structure and the kind of information they contain. A good example would show a doctor clearly stating they reviewed specific records (like your DD-214, service treatment records, and private medical records) and then providing a medical opinion, like: “It is at least as likely as not (a 50% or greater probability) that Veteran John Doe’s current diagnosis of degenerative disc disease is proximately due to or the result of the back injury sustained during parachute training in May 2005.” The letter would then explain the medical reasoning behind this conclusion.

How do I submit a nexus letter to the VA? 

Once you have a nexus letter from a qualified professional, you need to get it to the VA. You can submit it:

1. With your initial claim: Include the nexus letter along with your application (VA Form 21-526EZ) and other supporting documents.
2. Online: Upload the letter directly to your claims file through the VA.gov website or the eBenefits portal.
3. By Mail: Mail the letter to the VA Evidence Intake Center (check the VA website for the current address). Be sure to include your name and claim number (usually your Social Security number) on the letter.
4. Through your VSO or Attorney: If you’re working with a Veterans Service Officer (VSO) or an accredited attorney, they can submit the letter on your behalf.

How much does a VA nexus letter cost?  

The cost of obtaining a nexus letter can vary quite a bit. Your regular treating doctor might write one as part of your ongoing care, potentially at no extra charge, but many doctors are unfamiliar with the specific requirements of a VA nexus letter or may be hesitant to write one.

Often, veterans seek out private medical professionals who specialize in providing medical opinions for VA claims. These experts understand the VA’s requirements and terminology. The cost for these services can range from a few hundred to several thousand dollars, depending on the complexity of your case, the number of conditions, and the specific provider. While it’s an investment, a strong nexus letter can make a significant difference in the outcome of your claim, potentially leading to thousands of dollars in disability benefits over time.