Writing a "Nexus Letter" ***
- Michael D. Erickson LPC
- 6 days ago
- 3 min read
The VA Nexus Letter is a formal medical–legal opinion that links a veteran’s current diagnosed condition to their military service. Because these letters carry evidentiary weight in VA disability claims, they must be structured, precise, and compliant with VA standards.
Below is a clear, clinician-oriented framework for writing an effective Nexus letter.
1. Author Qualifications
The letter should be written by a licensed medical or mental health professional whose scope of practice covers the condition being addressed.
Include:
Full name and credentials (e.g., MD, DO, PhD, PsyD, LPC, LCSW, NP, PA)
License number and state
Specialty
Clinical experience relevant to the condition
Relationship to the veteran (treating provider vs. record reviewer)
2. Veteran Identification
Include:
Veteran’s full name
Date of birth (or last four of SSN)
Branch of service
Dates of active-duty service
3. Records Reviewed
Explicitly list all materials reviewed, such as:
Service Treatment Records (STRs)
Military personnel records
VA medical records
Private medical records
C&P examination reports
Lay statements (buddy statements, spouse statements, veteran’s own statements)
Example:
“I have reviewed the veteran’s service treatment records dated 2003–2007, VA medical records from 2010–2024, private orthopedic evaluations, and the veteran’s sworn lay statements.”
4. Current Diagnosis
State the current diagnosis, using DSM-5-TR or ICD-10 terminology when applicable.
Example:
“The veteran carries a current diagnosis of Major Depressive Disorder, recurrent, moderate (ICD-10 F33.1).”
5. Medical Rationale (Critical Section)
This is the most important part of the letter.
You must explain how and why the condition is linked to service using:
Medical reasoning
Chronology
Pathophysiology
Known risk factors
Peer-reviewed literature (when applicable)
Consistency of symptoms over time
Avoid conclusory statements without explanation.
Example:
“The veteran’s symptoms began during active-duty service following repeated blast exposure. Medical literature supports a causal relationship between blast exposure and later-developing neurocognitive and mood disorders…”
6. Nexus Opinion Language (VA Standard)
The opinion must use VA probability language.
Acceptable standard:
“It is at least as likely as not (a 50 percent probability or greater) that the veteran’s condition began during or is due to military service.”
Avoid:
“Possibly”
“Could be”
“May be related”
7. Address Alternative Causes (If Applicable)
Demonstrate that you considered other potential causes and explain why they are less likely.
Example:
“The veteran has no documented history of depressive symptoms prior to military service, and there is no evidence of an intervening post-service traumatic event that would better explain the condition.”
8. Functional Impact (Helpful but Optional)
Describe how the condition affects occupational and social functioning, aligning with VA rating criteria.
9. Signature and Attestation
Include:
Wet or digital signature
Date
Professional letterhead
Contact information
Sample Nexus Opinion Statement
“Based on a review of the veteran’s medical records, service history, clinical presentation, and relevant medical literature, it is at least as likely as not (50 percent probability or greater) that the veteran’s diagnosed Posttraumatic Stress Disorder is causally related to traumatic events experienced during active military service.”
Common Reasons Nexus Letters Are Rejected
No rationale provided
Incorrect probability language
Provider outside scope of practice
Failure to review service records
Overreliance on the veteran’s self-report without corroboration
Advocacy tone rather than medical opinion
Important Legal/Ethical Notes
You are not determining service connection—only providing a medical opinion.
Avoid absolute statements (“definitely caused by”).
The VA weighs credibility, rationale, and record review more than length.
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