What Is a Nexus Letter?

When preparing to file a claim for VA disability benefits, you may come across the term “nexus letter.” What is a nexus letter? A nexus letter is a formal medical opinion from a qualified doctor establishing a connection between your disability and your military service.

Key Takeaways
  • A nexus letter is a critical medical document linking a veteran’s disability to their military service, often crucial for VA disability claim approval.
  • It should be composed by a qualified doctor, including a comprehensive review of the veteran’s medical and service records, to assert the service connection of the disability.
  • While not mandatory, the absence of a nexus letter significantly reduces the likelihood of a VA claim’s success, particularly for conditions not explicitly documented during service or listed as presumptive by the VA.
  • Costs for a nexus letter can vary widely, from $400 to over $2,000, reflecting the comprehensive review and expertise required to substantiate the claim.

Submitting a nexus letter with your VA disability claim often enhances your chances of approval. In fact, not including one is more likely to result in a denial. Veterans Guide explains the importance of a nexus letter and when it’s necessary to get one.

When Do You Need a Nexus Letter?

First things first: No rule requires you to submit a nexus letter with your VA disability benefits application.

However, the VA states that most denials result when no nexus letter is submitted, or the nexus letter is inadequate. In other words, failing to submit a nexus letter reduces your chances of claim approval.

A nexus letter may not be necessary in the following situations:

Otherwise, you will likely need a nexus letter. A nexus letter is crucial to establish a service connection, especially if you didn’t receive a diagnosis until after your military service.

You should also include a nexus letter if you file a secondary service-connected claim. For instance, you may already have a disability approved by the VA and develop a new condition that directly relates to your original disability. Including a nexus letter with your claim for the secondary condition can help you tie the old disability to the new one. If the VA approves your claim, you may receive additional VA disability compensation, depending on your disability rating.

If the VA denies your disability claim, you may decide to appeal. If you do, you must submit sufficient evidence to persuade the VA to change its opinion. A nexus letter can support your case.

What Is Needed in a Nexus Letter?

A nexus letter is factual, to the point, and contains specific language to tie your disability to your time in service. It’s provided by a qualified doctor who, based on their examination and review of your medical records, gives an expert opinion on whether your disability is service-connected. 

The doctor provides their opinion based on evidence, typically including your military service medical files, other existing medical records, and a physical exam. The doctor may supplement their opinion with data or facts from medical journals or literature.

nexus letter infographic

What Components Should Be in a Nexus Letter?

A properly written nexus letter includes the following elements.

Identifying Information

The nexus letter should begin by listing the date, the veteran’s name, and Social Security number. If the veteran has a VA file number, it should also be included. Identifying information helps the VA tie the nexus letter back to your claim.


The introduction notes the doctor’s name and their specialty. It states that they are a board-certified medical doctor and describes the letter’s purpose—to provide their medical opinion on your disability and whether it’s service-related.

Statement of Evidence Review

Next, the doctor describes the evidence reviewed that forms the basis of their opinion. Evidence may include the veteran’s service records and medical records. If a specific incident led to your disability, the doctor may describe the event and the date it occurred.


The doctor will provide a diagnosis of the disability. The diagnosis is the type of medical condition you’re suffering from. The doctor may also indicate whether they’ve conducted a physical exam or other tests, such as lab work or X-rays.

Professional Opinion on Disability Cause

The doctor’s professional opinion is the most crucial part of the nexus letter. The letter should state the doctor’s opinion regarding the likelihood that your disability is service-connected. The doctor must choose a degree of likelihood from three choices: “At least as likely as not,” “More than likely,” or “Highly likely.” 

The strongest likelihood is “Highly likely,” but “as least as likely as not” is still considered favorable to the veteran.


Following the professional opinion, the doctor provides a supporting rationale to justify their assessment. The rationale can be based on personal experience, medical literature, or medical journals.


The doctor’s credentials include their specialty. If they’re a VA doctor, they will include their VA title.

Who Can Write a Nexus Letter?

The person who writes your nexus letter must be an expert—a licensed medical doctor. The VA won’t consider a nexus letter written by someone without a medical background. 

It’s important to seek a nexus letter from a doctor specializing in your disability. For instance, if you have a bone injury, you’ll want a nexus letter from an orthopedic surgeon. If you have PTSD, request a nexus letter from a clinical psychiatrist or psychologist. A doctor with knowledge specific to your disability will give your nexus letter additional credibility.

What Does a Nexus Letter Look Like?

Here is an example of a nexus letter that contains all the appropriate elements.

DATE _________________

Reference: (Veteran’s name) _________

SS# ________ VA File # _______________

To Whom It May Concern,

I am Dr. _________.  I am board-certified in my specialty. My credentials are included. I have been asked to write a statement in support of the aforementioned Veteran’s disability claim.

I have personally reviewed their medical history. (Name the Documents) I have also reviewed and noted the circumstances and events of their military service in the years ____________ (Event or Events claims as the cause of the condition) while they served during their military service. (List dates of service)

Mr/Ms/Mrs. ________ has been a patient under my care since (enter date). Their diagnosis is ___________ (Name the Condition).

I am familiar with their history and have examined Mr/Ms/Mrs. ________ often while they were under my care. (Specify Lab Work, X-rays, Etc.)

Mr/Ms/MRS. ________ has no other known risk factors that may have precipitated their current condition.

After a review of the pertinent records, it is my professional opinion that it is at least as likely as not that Mr/Ms/Mrs. ________’s condition is a direct result of their (Event) as due to their military service.

Based on my personal experience and the medical literature, it is known (Provide a rationale).


Dr. ______

How to Get a Nexus Letter

To get a nexus letter, you’ll need to see a doctor specializing in your disability. If you already have a treating physician specialist, you can request one from them. Otherwise, you may need to find a specialist who can examine you, review your prior medical records, and verify your disability. You can also ask your primary care physician for a referral to a specialist.

Some specialists know the nexus letter requirements and understand the VA’s disability review process. When scheduling an appointment with a specialist, you can ask about their experience with nexus letters.

How Do I Ask My Doctor for a Nexus Letter?

If you’re seeking a nexus letter from your current doctor, explain that you’re filing for VA disability benefits and would appreciate it if they could provide a nexus letter to support your claim. If they know your medical and service history and share your opinion that the disability is service-connected, you likely won’t have any problems.

However, if you need to see a new specialist doctor to obtain a nexus letter, it’s best to look for one with experience in the VA disability process. They will understand the elements required in a nexus letter and their responsibilities when providing an opinion.

What to Do if Your Doctor Won't Write a Nexus Letter

If your doctor won’t write you a nexus letter, ask why. Some doctors may not have enough experience with VA disability claims to feel comfortable writing a nexus letter. Others may not specialize in the disability. You can try to find another doctor with greater expertise in your disability or experience in the VA claims process.

If you cannot obtain a nexus letter, consider whether other evidence will sufficiently support your claim. For instance, you might provide witness statements from friends, family, or other veterans who served with you.

How Much Does a Nexus Letter Cost?

Writing a nexus letter isn’t as simple as drafting a short message on paper. While that’s the final product, the doctor must review your medical and service records and find medical literature to support their opinion. The review process can take time. Thus, doctors will charge accordingly for their services. 

Expect to pay anywhere from $400 to $2,000 or more for a full medical review and nexus letter. The cost will vary depending on the number of disabilities you have, the extent of your medical and service records, and how recently the disability occurred, among other factors.

Get Help With Your Nexus Letter

While obtaining a nexus letter may seem overwhelming, it’s well worth the time and effort. If you’re unsure where to start, reach out to Veterans Guide. We can help you with the process of obtaining a nexus letter and filing a VA disability appeal.

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