How to Get a Nexus Letter in 7 Steps
Getting a nexus letter for VA disability feels way harder than it should. Many veterans hit the same wall over and over — primary doctors refuse to write one, VSOs offer vague advice, and private companies charge hundreds or even thousands of dollars without guaranteeing results.
That leaves a lot of vets stuck, frustrated, and unsure who to trust.
This guide breaks the process down step by step. You’ll learn when you actually need a nexus letter, how to organize your evidence, where to find reliable doctors who write them, and how to request one the right way.
We’ll also cover common mistakes to avoid so you don’t waste time or money — and so you can finally get the service connection you deserve.
Step 1: Determine if You Need a Medical Nexus Letter
Most primary service-connected conditions are easier to prove, but secondary conditions usually need a VA nexus letter.
The VA specifically looks for evidence that links a veteran’s current disability or current medical condition to their military service when evaluating disability claims. If they cannot determine that, they need a nexus letter.
Primary Conditions
Primary conditions are disabilities that started during service or were directly caused by military duty. These claims often already have strong evidence in service treatment records, so you don’t usually need a nexus letter to prove that.
A nexus letter helps most if:
Your injury or illness wasn’t documented clearly in service
Your symptoms didn’t start until after discharge but are still related
A C&P examiner said there is no medical link
Your condition isn’t presumptive (granted) under VA rules
Here's the good news — nexus letters are generally way easier to get for primary conditions because it's easier for your doctors to see that direct link.
Secondary Conditions
Secondary conditions are disabilities caused or worsened by another service-connected condition. This includes cases where one condition led to another as well as cases where your time in service aggravates a pre-existing condition.
Nexus letters for secondary claims are almost always essential for a few reasons:
Alternative Causes: Many secondary conditions have other potential causes which need to be ruled out.
Delayed Onset: Secondary conditions often appear years after service, so the connection isn’t obvious without documentation.
C&P Denials: the VA heavily relies on Compensation & Pension exams, which frequently deny secondary claims
It can take a bit more time obtaining a nexus letter for secondary conditions can because you need the right doctor and a clear understanding of VA requirements.
Step 2: Create a Template & Clear Instructions
The first thing to do is create a custom nexus letter template for your condition. I’ve already created a detailed guide on the best nexus letter templates, so I won’t cover that here.
Next, you should prepare a one-page summary for your doctor that clearly outlines your case, including:
Timeline of Your Condition: Create an exact timeline showing: time in service → first symptoms → diagnosis → treatments.
Service Treatment Records (STRs): Highlight any complaints, injuries, or diagnoses during service that relate to your claim.
VA & Civilian Medical Records: Show ongoing treatment and how your symptoms progressed over time.
Buddy or Lay Statements: Include any statements from people who can corroborate in-service events or continuity of symptoms.
Prior C&P Exam Reports: Note where the examiner may have misunderstood or overlooked evidence, so your doctor can address it directly.
The more research and preparation you do yourself, the better. Trust me, a small time investment now will save you both time and money later.
Step 3: Choose the Right Type of Doctor
Not every doctor is a good fit for writing a nexus letter. Choosing the right provider depends on your condition, the complexity of your claim, and your comfort level with their experience.
Primary Care Doctors
Most people start with their primary care provider, which works well if your case is straightforward:
Good when:
You’ve had the same doctor for years: Doctors that know your medical history well may be more willing to write you a nexus letter.
Simple Service Connections: Conditions with an obvious link to an existing disability, like combat related PTSD or Tinnitus.
Not good for:
Complex Secondary Conditions: Claims needing expert reasoning, like PTSD → sleep apnea or chronic pain → depression.
Rare or Highly Technical Conditions: Conditions like certain cancers, autoimmune diseases, or cardiac complications secondary to medications.
Regardless, your doctor can be a great resource for organizing your medical information and verifying your medical records.
Specialists
A nexus letter from a specialist is often essential for complex or secondary conditions. Specialists add value through:
Expert knowledge: They understand your condition and can clearly explain how one issue caused or worsened another.
Credibility with the VA: The VA gives more weight to opinions from doctors who specialize in the relevant field.
Ability to address denials: Specialists can write detailed explanations to counter C&P exam findings or “no medical nexus” decisions.
While cost and finding the right provider can be challenges, a specialist’s input is often the key to getting your claim approved.
Nurse Practitioners
Nurse practitioners provide the lowest level of medical authority for nexus letters, so their opinions alone rarely sway the VA.
They often lack the specialized expertise needed to explain complex medical links.
Still, they can be valuable for support, especially if they’ve treated you over time and can verify your ongoing symptoms or treatment history.
Because they’re more accessible and affordable than specialists, their statements can serve as a helpful supplement to a primary nexus letter from a physician.
VA Doctors
To the frustration of veterans, VA doctors usually will not write a nexus letter. Ironically, they’ll treat you up just fine, but ask for a nexus letter and suddenly it’s classified information — go figure.
However, a VA doctor can still be useful for providing recommendations or detailed treatment notes. I’ll cover this more later in the article.
Paid Companies
In the vast majority of cases, paid companies should be a last resort.
While some veterans have received successful nexus letters through these services, it’s a large financial investment for inconsistent results at best.
I also recognize that many veterans have exhausted all other options and have no choice. For those people, I will cover best practices for finding a reputable company later in the article.
Step 4: Find a Doctor Who Will Write You a Nexus Letter
Finding a doctor who understands how to write a strong nexus letter can be the hardest part of the process.
It’s often a numbers game, and finding the right doctor can take time. Expect to contact at least 5-10 providers before landing on one who’s a good fit.
Start Locally
Begin by checking VA and community care options near you.
Go to VA.gov/find-locations.
Enter your city or ZIP code.
Under Facility Type, select VA Health or Community Care Providers.
Under Service Type, pick the specialty related to your claim (for example, psychology, orthopedics, or sleep medicine).
When you call, ask if they offer “record reviews” or “independent medical opinions”. Avoid saying “nexus letter” until you know they understand VA claims.
If they say yes, confirm whether the provider has written medical opinions for VA claims before.
Use Specialist Directories
If local options don’t pan out, search medical directories for specialists who perform Independent Medical Examinations (IMEs) or disability evaluations.
These terms are more widely recognized by doctors. Here are a few recommended places to search:
Psychology Today: For mental health–related claims (search by specialty and add “VA” or “PTSD”).
Zocdoc or Healthgrades: Use filters for your condition and location, then call or message offices about IMEs or record reviews.
American Board of Independent Medical Examiners (ABIME): Find certified IME doctors by state.
SleepFoundation.org’s provider directory: Ideal for sleep apnea or respiratory-related claims.
When using Google, try searches like:
Independent medical opinion + [city] + [specialty]IME for Veterans + [State]
Ask Veteran Service Organizations (VSOs)
VSOs can’t write nexus letters, but they often maintain lists of trusted providers who can.
Visit VA.gov/get-help-from-accredited-representative and contact local chapters of groups like the American Legion, DAV, or VFW.
Ask them directly:
“Do you have a list of doctors familiar with writing independent medical opinions or nexus letters for VA claims?”
They can sometimes point you toward specialists who’ve successfully helped other veterans.
Explore Trusted Paid Options
If you can’t find a local or VSO-recommended doctor, several private services specialize in nexus letters for veterans. Prices vary, so verify credibility before paying.
What to look for:
Doctor’s full name, credentials, and specialty listed
References to independent medical opinions or evidence-based rationale
Record review included (not pre-written templates)
Example vetting email to send before you buy:
Subject: Quick Questions About Your Nexus Letter Process
Hi [Company Name] Team,
I’m a veteran comparing providers for an independent medical opinion (nexus letter). Before moving forward, could you clarify a few quick points?
Is the letter custom-written after reviewing my medical/service records?
Do your doctors use VA language like “at least as likely as not”?
What’s the typical turnaround time?
Will I be able to speak directly with the doctor?
Is pricing flat-rate or based on case complexity?
Thanks — I appreciate your time.
[Your Name]
Step 5: Ask Your Doctor for a Nexus Letter the Right Way
Veterans have more control over whether a doctor agrees to write a nexus letter than they might think. Here are the practical steps you can take.
Prepare Your Outreach Pitch
The key to a good outreach pitch is to frame your request as asking for the doctor’s professional opinion, not a personal favor.
When providers see it as a medical review within their expertise rather than an extra task, they’re more open and confident about helping.
Example pitch:
Hi Dr. [Name], My name is [Veteran Name]. I served in the [Branch] from [Years]. I’m hoping you can review my records and provide a medical opinion about whether my [condition] is related to my service.
I’ve attached a one-page summary, my service records, and relevant treatment notes. I can also provide a short template to make formatting easier.
Please let me know if you’re open to reviewing them. Thank you for your time and consideration, [Your Name] [Phone/Email]
Tip: Attach only what’s necessary for a first review. Overloading them with hundreds of pages right away can discourage participation.
Call or Meet in Person
Once you have your outreach pitch, the next step is to follow up with a phone call or in-person visit.
Be polite, direct, and professional — think of it as a consultation, not a plea.
Briefly explain why you believe your condition is service-connected (for example, “I did some research and came across these studies for my condition”).
Offer to pay for their time if appropriate - Might be necessary since most doctors want to be paid for their time.
Consistency and courtesy go a long way. A short, confident explanation often earns more respect than a long emotional appeal.
Handle Objections
Many doctors may hesitate to write a nexus letter, often because of its complexity and their lack of VA knowledge. Here are a few common responses you might get and how to handle them professionally.
Example 1: “I don’t write nexus letters and have no experience”
You can respond with:
“I understand completely. Would you be open to doing a record review or providing a medical opinion instead?”
This shifts the focus from “nexus letter” (which some doctors associate with legal paperwork) to something they’re more comfortable with — a clinical review.
Example 2: “I’m not sure your condition is service connected”
You can say:
“That’s understandable. I have a short summary showing when my symptoms started and how they’ve progressed if you’d like to take a look.”
Offering evidence calmly shows you’re informed and gives them a chance to see your reasoning without pressure.
Example 3: “That’s a VA issue.”
You can clarify:
“I totally get that. I’m not asking for a legal statement—just your medical opinion on whether my service could have caused or aggravated the condition.”
This helps them see their role as purely medical, not administrative, which often puts them at ease.
Step 6: Strengthen Your Nexus Letter
Even with the right doctor, the quality of your nexus letter can make or break your VA claim.
These quick tips will help ensure your letter is as strong and credible as possible.
Be persistent: It may take several tries to find a doctor willing to review your records. Don’t get discouraged — persistence is normal and often what separates approved claims from denied ones.
Research real examples: Read examples of strong and weak nexus letters so you understand the tone, structure, and detail level that persuades VA reviewers. This helps you recognize what quality looks like.
Avoid boilerplate templates: Every case is unique. Doctors who use one-size-fits-all templates can weaken your claim because VA reviewers recognize generic or copied language immediately.
Keep copies of everything: Save all communications, drafts, and evidence you send or receive. Organized documentation makes follow-ups easier and protects you if anything goes missing in the VA system.
The main takeaway for veterans should be to do the most work you can possible. This will help you get the best nexus letter for the lowest cost.
Step 7: Take Alternative Actions if You Fail
If you’ve truly followed all of the steps in this guide thoroughly, it is highly unlikely you will reach this point.
But if you truly can’t find a doctor willing to write a nexus letter, here’s what you can do:
Strengthen your medical evidence: Make sure your treatment records and service history show a consistent continuity of symptoms over time.
Submit a Supplemental Claim: If you were denied for “no nexus,” add new and relevant evidence like medical research, buddy statements, or updated medical notes.
Consider lower-cost options: Ask providers if they offer record reviews or short medical opinions instead of full letters.
Use proper phrasing: Even a brief note stating “at least as likely as not” can strengthen your file.
Persistence pays off — most veterans need to contact several providers before finding one who’s both willing and qualified.
Getting a Winning Nexus Letter Takes Time
Getting a strong nexus letter takes time, patience, and organization — but it’s absolutely worth it.
The process itself is straightforward: gather your evidence, find the right specialist, and make a clear, professional request.
The hardest part is staying persistent long enough to find a doctor who understands VA claims. Putting in that extra effort now can save you years of frustration and denials later.
A well-written, evidence-based nexus letter is often the difference between a denied claim and the benefits you’ve earned through your service.
FAQ
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It depends. Your primary care doctor or nurse practitioner may be willing to write a nexus letter for free or for a small fee, especially if you’re already their patient. Specialists, on the other hand, often charge anywhere from $200 to $800, depending on the complexity of the case. Some private companies and expert medical reviewers can charge $500 to $2,000 or more for detailed independent medical opinions. Remember — a higher cost doesn’t always mean higher quality, so it’s important to look for experience and credibility rather than just price
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C&P exam doctors technically can write nexus opinions, and their opinions hold equal weight to those from your private doctor. However, you can’t hire or request them to write one in your favor — their job is to give an independent opinion for the VA. If a C&P examiner’s opinion goes against your claim, you’ll often need to get your own nexus letter from a qualified medical professional to counter or clarify their findings.
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You can get a nexus letter from a VA doctor, community care provider, private specialist, VSO-recommended doctor, or an independent medical company that offers IMEs. All of these options can work in some cases but not others — it depends on the doctor’s experience, how well they explain the medical link, and how strong your evidence is.
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The best doctor for a nexus letter is usually a specialist in the condition you’re claiming — like a sleep specialist for sleep apnea or a psychologist for PTSD — since the VA gives their opinions more weight. However, if your claim involves a straightforward primary condition such as a knee or back injury that’s clearly linked to service, your primary care doctor can often provide a strong nexus letter without needing a specialist. It really depends on how complex the medical link is.
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VA doctors can write nexus letters, but most won’t due to VA policy and workload limits. They’re often discouraged from giving opinions that could affect claim outcomes. Some may still provide supporting notes in your records, but if you need a formal nexus letter, it’s usually better to go through a private or community care doctor instead.
