Nexus Letter Examples: Best Template, Example Texts, & More
There's absolutely no shortage of nexus letter templates online — trust me, I've seen them all. Way too many veterans just download these fill-in-the-blank examples and hand them straight to their doctor without customizing them for their unique situation.
The result? The VA denies claims left and right that rely on these generic templates they've seen hundreds of times.
Writing a basic template is the easy part. The hard part is customizing it so your doctor knows exactly what to include and the right way to phrase it.
This guide provides a nexus letter template designed to far surpass generic examples, along with expert tips on customizing it specifically for your condition.
Why Most Nexus Letter Templates Don’t Work
The problem with basic nexus letter templates is that they oversimplify the complexity of individual cases.
Pre-Written Examples Mislead Your Doctor
Many prewritten nexus letter templates make it way too easy for a doctor to just fill in the blanks rather than analyze your unique case in detail.
Bad: "This veteran's back pain is at least as likely as not due to military service."
Good: This veteran’s chronic lower back pain began during active duty in June 2008 after repeated heavy lifting, with no prior history of back problems. Medical records confirm symptom onset during 2008–2009 while in service. Based on this evidence, it is at least as likely as not that the condition is related to military service
Most doctors have limited experience with nexus letters. A good nexus letter template gives the doctor a more detailed understanding of what evidence and reasoning is needed for your case.
One Template Won’t Fit Every Case
Every veteran’s case is different — and so is the nexus letter they need. Generic templates can’t account for your specific condition or the type of service connection you’re claiming.
You need a custom template for your doctor because:
Different connections need different reasoning. Secondary conditions often require more detailed medical evidence than templates suggest.
Each condition follows unique criteria. The VA rates back pain, tinnitus, PTSD, and sleep apnea using very different standards.
Your service history changes the story. The link between your symptoms and duties (combat, lifting, noise exposure, etc.) must be clearly shown.
Evidence must be personalized. What proves one veteran’s GERD claim might not apply to another’s hypertension.
Templates lead to vague conclusions. Without tailored reasoning, your doctor may miss the details the VA relies on to approve service connection.
Our goal in this article is to show you how to write your own nexus letter template so you can get the evidence you need to win your case.
Nexus Letter Formatting Essentials
A Nexus letter represents a doctors professional opinion that links your specific condition to your time in military. Here is how the basic format flows:
Header and Date: Doctor’s letterhead, address, and date.
Veteran Information: Veteran’s name and identifying info (no SSN or full DOB — usually last four digits or claim number).
Introduction / Credentials: Doctor introduces themselves, their specialty, and their clinical relationship with the veteran.
Medical Summary and Diagnosis
Overview of the veteran’s condition, when it began, relevant medical history.
Rationale and Evidence Review
Discussion of records, symptoms, and medical reasoning that links the condition to service.
Medical Opinion Statement (Nexus Statement)
The formal conclusion using VA language like: “It is at least as likely as not (50% probability or greater) that the veteran’s condition is related to military service.”
Signature and Contact Information
Doctor’s signature, printed name, credentials, and contact info.
We cover all the basic essentials of nexus letters in our guide to VA nexus letters, so check it out if you want the full breakdown.
Next, we’ll look at strong examples for each section of a nexus letter.
Nexus Letter Example Sections
Knowing what belongs in a nexus letter isn’t the same as using it correctly. Applying the elements properly is what makes the letter effective for a VA claim.
This can also help you later when you meet with your doctor because you can show exactly what the VA looks for in a nexus letter.
Proper Formatting
The nexus letter should be professionally structured, including headers, dates, reference information, the veteran’s name, and the doctor’s signature. Clear formatting ensures the VA can easily read and process the letter.
Bad Example:
“To whom it may concern, I think this veteran’s back pain is related to service. Signed, Dr. X.”
Lacks headers, dates, veteran details, and context.
Good Example:
Header: Dr. Jane Smith, MD – Orthopedic Specialist
Date: October 10, 2025
Patient: John Doe, DOB 01/01/1980, SSN XXX-XX-XXXXThis letter provides a medical opinion regarding Mr. Doe’s chronic lower back pain and its connection to military service.
Signature: Dr. Jane Smith, MD
Doctor’s Qualifications and Medical Specialty
The doctor must clearly state their credentials and area of expertise to establish authority and credibility in the VA claim.
Bad Example:
“I am a doctor and have seen the veteran in my office.”
Good Example:
“I am Dr. Jane Smith, MD, a board-certified orthopedic surgeon with 15 years of experience treating musculoskeletal injuries. I have evaluated Mr. John Doe for chronic lower back pain since 2018.”
Clinical Relationship
The letter should describe the doctor’s relationship with the veteran, including frequency of visits, treatment history, and ongoing care.
Bad Example:
“I have seen this veteran once and think his back pain is due to military service.”
This is too brief; lacks context or treatment history.
Good Example:
“I have treated Mr. John Doe since January 2018, with follow-up visits every 3–6 months for evaluation and management of chronic lower back pain. My care has included physical exams, imaging review, and therapy management.”
Diagnosis
A clear, specific medical diagnosis is essential. Vague symptoms (like “pain”) are insufficient; the VA needs a formal condition to establish service connection.
Bad Example:
“The veteran has back pain and headaches.”
This only lists symptoms; no formal diagnosis.
Good Example:
“Mr. John Doe has been diagnosed with lumbar degenerative disc disease (ICD-10 M51.36), confirmed by MRI and clinical evaluation, consistent with his reported symptoms and history of service-related physical activity.”
Medical Rationale
The nexus letter must explain why and how the veteran’s condition is connected to military service, using evidence and clinical reasoning rather than assumptions.
Bad Example:
“It is my medical opinion that the veteran back pain is related to service.”
Unsupported opinion; no evidence or reasoning.
Good Example:
“Mr. Doe’s lumbar degenerative disc disease began during active duty after repeated heavy lifting and training exercises. Service treatment records show complaints of back pain during deployment, and post-service imaging confirms progression. Alternative causes such as age-related degeneration, prior injuries, and lifestyle factors have been considered and ruled out as primary contributors.”
What Does a Nexus Letter Look Like?
Your specific condition will significantly influence how your nexus letter will look. Below are a few examples
Primary Connection Letters (Shorter)
Why they’re shorter:
Primary nexus letters link a condition directly to military service, often based on a well-documented event or in-service injury.
Since the cause is clear and the service connection straightforward, less explanation is needed.
VA reviewers can quickly see the link between the condition and service without extensive medical reasoning.
Conditions that don’t need a long letter:
Back Pain: Veteran injured lifting heavy equipment during service.
Tinnitus: Hearing loss from exposure to gunfire or machinery.
PTSD (direct claim): Nexus letters for PTSD usually cover combat trauma, MST, or witnessing a life-threatening event.
Hypertension: Diagnosed in service with documented elevated readings during active duty.
Secondary Connection Letters (Longer)
Why they’re longer:
Secondary nexus letters show a condition caused or worsened by another service-connected disability.
They require more detailed medical reasoning, because the connection is indirect and the VA needs evidence that the primary condition led to the secondary one.
These letters often include timelines, symptom progression, medical studies, and alternative cause analysis.
Conditions that may need a longer letter:
PTSD → Sleep Apnea: How chronic stress and disrupted sleep from PTSD contributed to sleep apnea.
Chronic Back Pain → Hypertension: Chronic pain causing stress, elevated blood pressure, or medication side effects.
Tinnitus → Head Injury: Head trauma worsening hearing issues and ringing in the ears.
GERD → Sleep Apnea: Acid reflux linked to sleep disruption, compounded by existing respiratory or stress-related conditions.
Simple Starter Nexus Letter Template
Below is an example of a strong nexus letter template. While you should not copy it word-for-word, it provides a clear illustration of what the VA looks for and how to write your own template effectively.
Header – Credentials & Introduction
I am a licensed [Doctor’s Title], specializing in
[Medical Specialty].
I have been evaluating [Veteran Name] since
[Start Date], with appointments occurring
[Frequency and Nature of Visits], regarding
[Condition / Medical Issue].
Purpose of the Letter
This letter provides a medical opinion on [Condition] and its connection to [Veteran Name]’s military service.
Records Reviewed
I reviewed [Veteran Name]’s service treatment records,
which show [Key Events].
I also reviewed post-service medical records and diagnostic results. Together, these records provide important
context for how [Condition] developed and progressed.
Relevant Medical History & Symptom Timeline
The veteran’s symptoms began [Describe Onset] and have progressed as follows: [Describe Progression and Impact]. These symptoms match [Condition] and are consistent with the veteran’s medical history.
During this time, [Veteran Name] has tried treatments such as [List Treatments], which provided [Describe Effectiveness].
Medical Reasoning and Causation
I considered other possible causes, including [List Alternatives], but found them less likely than a service-related cause.
Supporting evidence includes [List Records / Exams / Buddy Statements / Diagnostics] and supports the connection between [Veteran Name]’s condition and military service because [Give Specific Examples].
Analysis of VA Examination (if applicable)
In reviewing the VA exam from [MM/DD/YYYY], the examiner concluded [Insert VA Examiner’s Conclusion].
After reviewing the veteran’s full medical and symptom history, I find this conclusion [Explain Why Insufficient or Inaccurate].
Formal Nexus Opinion
It is my professional medical opinion that [Condition] is at least as likely as not (50% or greater probability) related to [Veteran Name]’s military service.
Signature Block
Sincerely,
[Doctor’s Name, Title, Credentials]
[Date]
Completed Nexus Letter Example
Below is an example of a nexus letter for a secondary condition. Keep in mind that every case is different, and yours may not require this level of detail
Thompson Sleep Center
Dr. Sarah Thompson, MD – Board-Certified Sleep Specialist
123 Health Way, City, State ZIP
Phone: (555) 123‑4567 | NPI: 1234567890
Date: October 4, 2025
Re: Mr. John M. Reynolds, DOB 03/14/1985
Service: U.S. Army, 2003–2010
To Whom It May Concern:
I evaluated Mr. Reynolds for sleep-related concerns. Based on his clinical history, sleep study results, service records, and ongoing treatment, it is my professional medical opinion that his obstructive sleep apnea (OSA) is at least as likely as not caused or aggravated by his service-connected PTSD.
Diagnosis & Clinical Findings
Polysomnography (July 22, 2024): moderate OSA, Apnea-Hypopnea Index (AHI) = 23
Symptoms: chronic sleep disruption, excessive daytime fatigue, morning headaches, loud snoring, gasping, pauses in breathing
Symptom onset: months after military discharge; persistent despite conservative treatments
Service-Related Factors
Documented PTSD during military service causing hyperarousal and sleep fragmentation
In-service nasal trauma contributing to airway obstruction
PTSD-related medications leading to weight gain, increasing OSA risk
Literature supports a link between PTSD and OSA:
Nighttime arousals and fragmented sleep increase airway collapsibility (pubmed.ncbi.nlm.nih.gov/22893807)
CPAP treatment improves both OSA and PTSD symptoms (pubmed.ncbi.nlm.nih.gov/31042558)
Alternative Causes Considered
Aging: patient is younger than typical idiopathic OSA onset
General obesity: weight gain correlates with PTSD medication, not pre-existing obesity
Alcohol use: minimal and controlled
Conclusion / Nexus Opinion
Based on:
Objective diagnostic testing
Documented service-connected PTSD and in-service nasal trauma
Ongoing symptoms despite lifestyle interventions
Supporting peer-reviewed literature
It is my medical opinion that Mr. Reynolds’ obstructive sleep apnea is at least as likely as not secondary to or aggravated by his service-connected PTSD. This supports his VA claim for secondary service connection.
Sincerely,
Dr. Sarah Thompson, MD
Board-Certified Sleep Specialist
[Signature]
*The letter is long because it is a secondary condition. Other conditions may not require this much detail. For example, tinnitus nexus letters usually don’t need as much detail unless its for a secondary claim.
Final Thoughts on Nexus Letters
This guide provides clear, real-world examples of nexus letters to help veterans understand how to effectively establish service connection for their medical conditions.
Each example highlights the critical components that VA reviewers look for, including detailed medical reasoning, references to service records, and precise language linking a condition to military service.
By reviewing these examples, veterans and their healthcare providers can see how a properly drafted nexus letter strengthens a claim, avoids common pitfalls, and increases the likelihood of a successful VA decision.
FAQ
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A nexus letter can vary in format, but it generally includes the veteran’s diagnosis, relevant medical and service history, and the doctor’s opinion connecting the condition to military service. While the layout differs, the key is that it clearly explains how the condition is “at least as likely as not” related to service.
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While a veteran cannot write their own nexus letter, they can create a detailed template or outline to guide their doctor. This template can include the veteran’s medical history, relevant service events, and the specific connection they need the doctor to address. By providing this information, the doctor has a clear roadmap for writing the letter, ensuring it meets the VA’s requirements and strengthens the claim
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A general rule is that a nexus letter is needed when the VA does not have enough evidence to establish a service connection or when there’s a legitimate question about whether the condition is related to service. Essentially, it’s used to fill gaps in the record and provide the medical opinion necessary to support the claim
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A nexus letter is a formal medical opinion written by a licensed healthcare professional linking a veteran’s current medical condition to their military service
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No. Templates are only for guidance. Each nexus letter must be individualized for the veteran’s specific claim and supported by medical evidence
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Cite medical records, service records, diagnostic tests, and relevant peer-reviewed studies. Providing a clear, evidence-based rationale strengthens the opinion
