Nexus Letter Examples: Clear Template, Real Samples, & 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.
Why the VA Discounts Pre-Written Templates
The VA often denies claims with generic nexus letters because they lack individualized medical analysis and fail to show how the evidence applies to the veteran’s specific circumstances
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 Can’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 what a good nexus letter template looks like so you can understand what it actually takes to win your claim.
Why Nexus Letters Don’t All Look the Same
Some nexus letters are several pages long, while others are just a brief summary. Below are a few reasons that some need more detail to prove service connection.
Some Conditions Need More Medical Explanation
Certain medical conditions naturally require more explanation. Sleep apnea, for example, is much more medically complex than a knee injury.
For complex claims, the doctor must break down the connection thoroughly—explaining how each underlying condition contributes to the claimed disability—so the VA clearly understands the medical link.
Some Claims Require Stronger Evidence
Primary service connection claims (directly linked to service) can be simpler if records clearly show the condition in service.
Secondary claims (linked to another service-connected condition) often require more explanation, because the VA must see the medical link between the primary and secondary condition.
Typically, the VA has very different nexus letter requirements depending on the type of service connection.
Finding the Right Balance Between Detail and Simplicity
In general, it is better to include more detail rather than too little. However, don’t let your doctor overwhelm the VA with information.
Don’t list every symptom you’ve ever had. Only document symptoms that are medically connected to the claimed condition or the service connection argument.
It’s best to cover all VA nexus letter requirements using as few words as possible. The VA prefers letters that are concise yet thorough.
Good vs Bad Nexus Letter Examples
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.
Correct Nexus Letter 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-XXXX
This 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 Credentials and Specialty
❌ 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.”
Your Doctor to Patient Relationship
❌ Bad Example
“I have seen this veteran once and think his back pain is due to military service.”
✅ 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.”
Clear Medical Diagnosis
❌ Bad Example
“The veteran has back pain and headaches.”
✅ 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.”
Strong Medical Reasoning
❌ Bad Example
“It is my medical opinion that the veteran back pain is related to service.”
✅ 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.”
Simple Nexus Letter Template You Can Start With
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]
Nexus Letter Examples for Specific Conditions
Different conditions require completely different medical explanations.
A generic template can help you understand the structure, but it won’t show you what actually works for your exact condition.
To make this easy, I’ve created detailed, condition-specific guides so veterans can skip the vague templates and see exactly how their claim should be supported.
For examples related to your condition, read our guides for:
Studying examples tailored to your condition is the most effective way to understand what a strong nexus letter should say.
How These Examples Can Help You Win Your Claim
Understanding these nexus letter examples helps you see what the VA is looking for in a clear, credible, and thorough medical opinion.
By comparing good and bad examples, you can ensure your own letter includes the right level of detail, documents the medical connection accurately, and avoids common mistakes that could weaken your claim.
Ultimately, knowing what works makes it easier to provide the VA with the evidence they need to approve your service connection
FAQ
-
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.
-
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
-
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
-
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
-
No. Templates are only for guidance. Each nexus letter must be individualized for the veteran’s specific claim and supported by medical evidence
-
Cite medical records, service records, diagnostic tests, and relevant peer-reviewed studies. Providing a clear, evidence-based rationale strengthens the opinion
