VA Nexus Letters: Ultimate Guide
Many veterans run into the same frustrating problem when it comes to VA nexus letters. They know it’s one of the most important pieces of evidence for a VA disability claim, but getting one feels confusing and overwhelming.
Who writes it? What should it say? And why do so many claims get denied even after a veteran submits a letter?
The truth is, most veterans don’t fully understand what makes a nexus letter strong in the eyes of the VA.
Without the right medical evidence, clear language, and professional backing, the letter can be dismissed or carry little weight. This leads to delays, denials, and veterans feeling stuck in the claims process.
That’s where this guide comes in. We’ll break down everything you need to know about nexus letters. We will cover what they are, why they matter, who can write them, and how to make sure yours gives you the best chance at a successful claim.
What is a Nexus Letter?
A nexus letter is a written medical opinion from a licensed healthcare provider that connects your current disability to your military service — or to another service-connected condition.
In plain terms, it’s a doctor saying:
“It’s at least as likely as not that this veteran’s condition was caused or aggravated by their service.”
You don’t need to prove the connection with 100% certainty — just show there’s an equal or greater chance that service played a role.
Medical Nexus Requirements
A strong nexus letter must:
Be written by a qualified medical professional (MD, DO, NP, or psychologist).
Include clear medical reasoning, not just a statement of belief.
Use VA language such as “at least as likely as not” (50% or greater probability).
Reference the evidence reviewed — service records, medical files, or exams.
Example:
If a veteran develops PTSD after a documented in-service trauma, the nexus letter should explain how and why that trauma is just as likely to have caused the PTSD as any other factor.
Nexus Letter vs. Nexus Statement
Both show that your condition is service-related — the difference is in depth and detail.
Nexus Letter:
Full medical opinion from a doctor.
Includes diagnosis, medical history, and rationale.
Carries more weight because it’s evidence-based.
Nexus Statement:
Brief summary that mentions a possible link.
Lacks detailed explanation or supporting evidence.
May help, but rarely changes a tough claim on its own.
Always clarify what your provider is giving you — the VA values a detailed, medically reasoned letter far more than a one-paragraph statement.
How It Fits into a VA Claim
To win a VA disability claim, you must prove three things:
Current Diagnosis – A verified medical condition.
In-Service Event or Injury – Something that happened during service.
Medical Nexus – A doctor’s opinion linking the two.
That third element — the nexus — is what this letter provides. Without it, the VA usually can’t grant service connection.
Who Can Write a Nexus Letter?
If you’ve done any research, you’ve probably seen people say a nexus letter only “counts” if it comes from a certain source. The truth is that the quality of reasoning and qualifications of the doctor are what matters most, not who wrote it.
Primary Care Provider: A good starting point since they already know your medical history. They offer decent credibility and are often easier to reach locally, especially if you’ve had a long, consistent relationship with them.
Nurse Practitioner – While their opinions carry less weight with the VA, they’re typically more accessible and can still help by verifying ongoing symptoms or treatment. These nexus letter work best as supporting evidence.
Specialist – Brings high medical credibility and is often necessary for complex or secondary conditions. Specialists can clearly explain how one condition caused or worsened another, though they may be more expensive.
Veterans Service Organizations (VSOs) – VSOs can’t write nexus letters, but they’re one of the best free starting points. They can guide you toward reputable doctors and explain what kind of letter you need.
Paid Companies – These are easy to access but vary greatly in credibility and quality. They usually have a good understanding of VA language, but are prone to using generic templates. You should only hire a company as a last resort.
In the end, the best source for a nexus letter depends on your specific condition and the doctors available to you.
How Do I Get a Nexus Letter?
Getting a nexus letter takes a bit of preparation, but the process is simple once you know what the VA looks for. Here’s the short version — for full examples and templates, see our step-by-step guide on how to get a nexus letter.
1. Determine if You Actually Need One
Not every claim requires a nexus letter. You typically need a nexus letter if the service connection is unclear, you’re filing for a secondary condition, or your C&P exam didn’t go in your favor.
2. Create a One Page Summary of Your ecords
Organize your service treatment records, VA medical files, private medical notes, and any buddy or lay statements by timeline. You should also document the timeline and severity of your symptoms.
3. Research Thoroughly
Start by asking your own doctor — sometimes they’re willing to provide a medical opinion if you explain exactly what you need.
If that doesn’t work, get recommendations from your local VA Medical Center, a Veterans Service Organization, or explore specialist directories like ABIME for complex cases
4. Ask Doctors the Right Way
Call or meet your doctor in person instead of emailing. Start by asking for a medical opinion, not a “nexus letter”.
Most doctors are more comfortable giving a professional opinion once they understand what you need. If they agree, provide a short summary or template to make it easier for them to review your case
5. Be Patient and Persistent
Most veterans contact several providers before finding one willing to help. Stay organized, follow up politely, and don’t get discouraged. It is absolutely worth it to find the right doctor, even if it takes some time
To properly submit your nexus letter, visit the VA’s Supporting Evidence Page. When uploading online, choose “Supporting Documents or Evidence”.
Nexus Letter Requirements
A strong nexus letter is more than just a doctor’s note—it must meet VA standards to carry weight.
Here’s what a good nexus letter should include:
Doctor Credentials – Include the doctor’s name, specialty, board certifications, and ideally a CV to show credibility.
Evidence Reviewed – The doctor should address all records including denials, failed C&P exams, and any other evidence mentioned
Diagnosis – Clearly state a medical condition the patient has and how they reached that conclusion, including tests, exams, and medical literature if relevant.
Medical Reasoning – The most important part. The doctor should clearly explain why the condition is related to military service, reference medical literature, and rule out other likely causes.
VA Language – Use VA-specific language, like: “It is at least as likely as not (50% or greater probability) that the veteran’s condition is related to military service.”
Signature & Contact – The letter must be signed with full credentials and include contact information for follow-up if the VA needs clarification.
Later, I will show real examples and what applying this information looks like in practice.
Nexus Letter Example & Format
Here is a nexus letter example Below is a sample nexus letter for a veteran with tinnitus caused by prolonged noise exposure during active duty.
Keep in mind that this is a general illustration — every veteran’s case will differ based on their medical history and supporting evidence.
Sample Tinnitus Letter
[Dr. Jane Smith, M.D. – Internal Medicine]
123 Main Street
Richmond, VA 23220
(555) 555-5555
Date: September 11, 2025
Reference: John R. Doe
VA File #: 123-45-6789
To Whom It May Concern:
I am Dr. Jane Smith, a board-certified physician in Internal Medicine, licensed in the state of Virginia. I have been asked to provide a medical opinion in support of Mr. John Doe’s VA disability claim for tinnitus.
I have reviewed Mr. Doe’s service treatment records, VA medical records, and private medical records.
I also reviewed details of his service, which include documented exposure to small arms fire, heavy weapon training, and aircraft engine noise during his active duty from 2005 to 2009.
(Annotation: This shows the doctor reviewed both service records and medical evidence — critical for credibility.)
Mr. Doe has been under my care since March 2020. His current diagnosis is bilateral tinnitus, confirmed through an audiological evaluation dated February 2021, which also showed a mild high-frequency sensorineural hearing loss.
(Annotation: A formal diagnosis and test results anchor the medical legitimacy of the claim.)
He reports persistent ringing in both ears, described as a high-pitched, constant tone that worsens in quiet environments. According to his history, symptoms began in 2007, while assigned to a firing range unit, and have continued without significant remission since separation from service.
(Annotation: This timeline connects the in-service event with ongoing symptoms — key for establishing continuity.)
Mr. Doe denies any history of civilian occupational noise exposure, head trauma, or ototoxic medication use, which could otherwise explain his symptoms.
(Annotation: This rules out alternate causes, which strengthens the doctor’s reasoning.)
After reviewing all available evidence, it is my professional opinion that Mr. Doe’s tinnitus is at least as likely as not (50% probability or greater) the result of his in-service noise exposure.
Rationale:
Service History & Event: Mr. Doe’s service treatment records confirm repeated exposure to weapons fire, artillery, and aircraft noise without consistent hearing protection.
Timeline of Symptoms: Veteran reports onset of ringing during active duty in 2007, with persistence since separation. This is consistent with noise-induced tinnitus as documented in the medical literature.
Medical Reasoning: Chronic noise exposure is a well-established cause of tinnitus. The presence of mild high-frequency hearing loss supports this diagnosis. The absence of significant post-service exposure or other medical explanations further supports a direct service connection.
Sincerely,
Dr. Jane Smith, M.D.
Board Certified in Internal Medicine
Virginia License #: 56789
Do I Need a Nexus Letter for Every Condition?
The biggest thing that determines whether you need a nexus letter is whether you are filing for a primary or secondary condition.
Primary Conditions
Most primary conditions don’t need a nexus letter. These are disabilities that clearly began during service or are directly tied to an in-service injury, illness, or event.
When the service connection is obvious, such as combat related PTSD, the VA usually doesn’t require a separate medical link.
Some exceptions include:
Your symptoms developed years after discharge but are still tied to something that happened in service.
Your condition isn’t presumptive — meaning it’s not automatically granted under VA rules.
A prior C&P examiner said there’s no medical link between your condition and your service.
In these cases, a well-written nexus letter can help fill the gap and give the VA the medical reasoning it needs to approve your claim.
If you can’t get a nexus letter, buddy statements and lay statements can sometimes bridge the gap.
Secondary Conditions
Examples include migraines from a traumatic brain injury, or high blood pressure caused or aggravated by PTSD.
Nexus letters for secondary conditions need to clearly explain the “cause and effect” relationship. They need to show the following things:
How the first condition caused or worsened the second.
The timeline of each condition
Rule out other possible causes, since secondary conditions may have multiple contributing factors.
Without that thorough medical explanation, the VA may not recognize the connection, even if it seems obvious to you.
How Much Do Nexus Letters Cost?
Nexus letters typically cost $500–$3,000, depending on your case and the doctor’s expertise. But price doesn’t equal quality . A well-reasoned $300 letter can be far stronger getting a $2,000 one from a sketchy company.
When It’s Cheap or Free
Sometimes you can get a strong nexus letter for cheap or even free — especially if your VA disability is straightforward and you handle most of the prep yourself.
You have a good relationship with your PCP: Doctors who know your medical history are more likely to write a letter or include the nexus opinion directly in your records.
You do research and front-end work: Organizing your evidence, timeline, and summary makes the doctor’s job easier and reduces the time they need to spend reviewing your case.
You have a relatively simple case: If the link between your service and condition is obvious — like tinnitus or a documented injury — a basic letter from your provider may be enough.
Be prepared to spend a little bit regardless since most doctors want to be paid for their time.
When It’s Expensive
Some nexus letters cost more because the case requires extra time, expertise, or effort to verify.
You change doctors frequently: Without a consistent provider who knows your history, new doctors must spend more time reviewing records before forming an opinion.
You have a secondary condition: These claims require detailed medical reasoning to explain how one condition caused or aggravated another, which often means hiring a specialist.
Limited local resources: If there aren’t many qualified providers nearby, you may need to pay for a specialist review or use an independent medical examiner (IME) online.
If your case is especially complex, it may be worth investing in a specialist who can provide a detailed, well-supported medical opinion that meets VA standards.
What Happens After You Submit a Nexus Letter?
After submitting your nexus letter, the following steps outline how the VA reviews and responds to your claim.
1. How the VA Reviews It
VA raters are required to consider all evidence in your file — including your C&P examination, nexus letter, and service treatment records.
If a C&P exam conflicts with a nexus letter, the VA is supposed to give the benefit of the doubt to the veteran. They don’t favor one source over the other — what matters most is the medical reasoning behind each opinion.
2. How Long It Usually Takes
There’s no fixed timeline. Some claims move in a few weeks, while others take several months, depending on backlog and complexity.
You can track your claim’s progress on VA.gov/claim-or-appeal-status.
3. What to Do if It’s Denied
Unfortunately, the VA process isn’t perfect and the nexus letter success rate can vary widely even if you do everything right
Before appealing, do a thorough audit of your entire submission to make sure your evidence, nexus letter, and medical reasoning are as strong as possible
4. Next Steps: Supplemental Claims, HLR, or Appeals
If you truly believe the VA made a mistake, file a Higher-Level Review (HLR) to have a senior rater reexamine your claim.
If you realize your letter or evidence was incomplete, file a Supplemental Claim with new or stronger documentation.
In more complex or repeated denials, you can take your case to the Board of Veterans’ Appeals for a full review.
Nexus Letter Myths vs Facts
Nexus letters are denied constantly. Below are some common misconceptions about nexus letters and why they are false
Myth: The VA always discounts private nexus letters.
The VA weighs all medical evidence based on its probative value (how detailed, reasoned, and credible it is). A well-supported private opinion can carry just as much weight as a VA doctor’s.
Myth: Paid nexus letters are better than free nexus letters
Paying for a letter doesn’t guarantee success. If the letter is templated or lacks individualized reasoning, it can actually be given less weight by the VA.
Myth: VA doctors are always superior to private doctors.
Neither has automatic priority — what matters is the quality of the medical opinion. In fact, private doctors sometimes provide stronger reasoning, especially if VA examiners overlook evidence.
Myth: If the VA doesn’t mention your nexus letter in the decision, it doesn’t matter.
The VA is required to consider all evidence. If your nexus letter isn’t addressed, that could be a procedural error and grounds for appeal.
Myth: Symptoms alone are enough for a nexus letter.
Symptoms must be tied to a diagnosis and connected to service (or to a service-connected condition). Without that link, a nexus letter won’t hold weight.
Myth: Every VA claim requires a nexus letter.
Not always. If your condition was diagnosed and documented during service, a nexus letter may not be necessary at all.
Final Thoughts on Nexus Letters
In short, a VA nexus letter is a critical tool for proving the connection between your service and your medical condition.
Knowing what it is, who can write it, and what makes it effective can dramatically improve your chances of a successful claim.
By approaching nexus letters strategically and ensuring your letter is credible, well-documented, and tailored to your condition, you give yourself the strongest possible support for your VA disability claim.
FAQ
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The cost of a nexus letter can vary — some are free, while others may range from around $500 to several thousand dollars. However, a higher price does not automatically mean a better letter. What matters most is finding a trusted doctor who provides a well-reasoned, individualized opinion. Be cautious with paid services that simply copy and paste; the VA gives little weight to generic letters.
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A veteran cannot submit a nexus letter on their own, but they can draft a template, organize supporting evidence, and then have a doctor review and finalize it. This approach is often more affordable than paying for a fully written letter from scratch.
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Technically, VA doctors can write nexus letters, but many choose not to. The reason is often a conflict of interest — their role is to provide treatment within the VA system, not to support or challenge disability claims.
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Yes, for secondary claims, a nexus letter is even more crucial because it explains how one service-connected condition caused or aggravated another.
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Be direct and professional. Bring your medical records, explain why you believe your condition is service-related, and ask if your doctor feels comfortable providing a medical opinion.
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A nexus letter is treated as medical evidence and becomes part of your VA claims file. It is not a VA form, but supporting documentation for your claim.?
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You generally don’t need a nexus letter for a higher rating if you are already service connected for that condition. You only need one for a rating increase if you are filing for a new condition.
