When Do You Need a Nexus Letter for a VA Claim? 

VA disability claims can be complex and frustrating, particularly when it comes to proving service connection for your condition. A Nexus Letter is often the missing piece that help veterans establish the link between their military service and their current disability.

But when do you need a Nexus Letter for a VA claim?

In this blog, we’ll explain the who, what, and why of getting a Nexus Letter and how to obtain and submit it to the VA for your claim. 

We’ll also share the top five scenarios when you should absolutely consider getting a Nexus Letter for your VA claim.

Key Takeaways

• A Nexus Letter is a document written by a licensed provider that links a veteran’s disability to their military service. 

• The VA does not require veterans to provide a Nexus Letter, but the letter may be needed to support denied claims, secondary conditions, and cases lacking strong medical evidence. 

• A Nexus Letter includes a well-supported, comprehensive statement based on the veteran’s service records and medical history. 

• Knowing how and where to get a Nexus Letter and how to submit it properly can increase your chances of a successful VA claim. 

What is a VA Nexus Letter?

A Nexus Letter is a document based on medical evidence that helps veterans establish a link or connection (i.e., a nexus) between their current diagnosis and an in-service-related event or trauma.  

When a secondary service connection needs to be established, the Nexus Letter can show that your primary condition is directly related to or “aggravates” another disorder, which is the verbiage VA raters need to see to approve your claim.   

A strong nexus letter needs to: 

• Clearly state your current diagnosis 

• Explain how your condition is linked to military service (direct, secondary, or aggravated connection) 

• Utilize medical evidence, research, and rationale to support the provider’s (i.e., the Nexus Letter writer’s) opinion 

• Include the doctor’s credentials and signature 

See also: What is a Nexus Letter?

When Do You Need a Nexus Letter for a VA Claim?

Proving service connection is often the most challenging part of a veteran’s VA disability claim. Regardless, not all claims necessarily require a Nexus Letter for approval.

Here are the top five scenarios to get a Nexus Letter for your VA Claim: 

• Your service records do not explicitly notate your diagnosis or symptoms of your condition. 

• Your current medical diagnosis/condition was not documented during active duty but developed after discharge. 

• Your VA disability claim was denied due to insufficient evidence supporting service connection. 

• You are filing a claim for VA benefits years after military separation. 

• You are filing a VA claim for a secondary condition. 

When don’t you need a Nexus Letter?

You will likely not need a Nexus Letter when: 

• Your disability was diagnosed and documented in your service records, and your medical records clearly show the link between an in-service event or trauma associated with your current diagnosis. 

• The VA has already granted you service connection. 

• You qualify for presumptive service connection (many conditions, such as certain cancers from Agent Orange or Gulf War Syndrome, are automatically presumed to be service connected based on qualifying criteria) 

Related: Gulf War Presumptives Guide, PACT Act Presumptive Conditions List

Questions to Ask When Determining if You Need a Nexus Letter

Was I diagnosed with a long-term disability during my military service, and do my military records reflect that diagnosis?

If you answer yes, you likely don’t need a Nexus Letter. 

Am I filing a VA claim for secondary service connection OR a claim that was previously denied service connection?  

If yes, you should absolutely consider getting a nexus letter.   

Am I filing for a VA rating increase?  

If so, you will not need a nexus letter since your condition has already been service connected. 

How to Get a Nexus Letter for a VA Claim

You may wonder how to get a Nexus Letter from a doctor or other qualified provider for a VA Claim. If you need a Nexus Letter, follow these steps to get one from a qualified psychologist, physician, licensed nurse practitioner, or qualified physician’s assistant: 

1. Gather your medical and service records.  

2. Provide your doctor with VA and private medical records, service treatment records, and any past claim decisions. 

3. Schedule an evaluation appointment. 

4. The provider will review your records and may perform a physical exam, if necessary, before drafting the Nexus Letter. 

5. The provider will write the Nexus Letter, including concise language regarding service connection, including the verbiage describing your condition as “at least as likely as not” having caused or contributed to your disability with supporting medical evidence.  

6. The provider will sign the letter, ensuring that their credentials are included. 

By working with an experienced Nexus Letter doctor, veterans can increase their chances of getting their VA claim approved. 

Some telemedicine providers, such as those at Telemedica, specialize in writing strong Nexus Letters.

How Do I Submit a Nexus Letter to the VA?

Once you have your Nexus Letter, submit it as part of your VA claim or appeal. Nexus Letters can be submitted at any time during the VA claim process. However, providing the letter with your VA initial, Supplemental Claim, or Board Appeals Process Claim submission is recommended.  

Here’s how: 

• Upload the Nexus Letter through your VA.gov account under your disability claim (or) 

• Mail your claim and Nexus Letter to the VA Evidence Intake Center – Send a copy of your Nexus Letter with your VA Form 21-526EZ (for new claims) or VA Form 20-0995 (for supplemental claims) (or) 

• Submit your claim and Nexus Letter in-person at a local VA regional office near you. 

• Work with a VA-accredited representative to help you submit your Nexus Letter correctly. 

The Nexus Letter must be correctly submitted to the VA for it to be considered part of the review process so that you can receive the benefits you deserve.  

What document in the VA does a nexus letter fall under?

Medical evidence, including Nexus Letters, falls into the category of supporting documents for VA disability claims. This document is uploaded to the VA’s “DBQ” or “Personal Medical Records” section.  

You can upload the letter online through the “VA Upload Medical Evidence” page. 

Note: Any evidence reviewed along with your claim, other than the VA’s medical records, is usually reviewed along with a Disability Benefits Questionnaire (DBQ). The DBQ form is a condition-specific form with details about your symptoms, diagnostic tests and other information that supports your claim.  

What’s the Difference Between a Nexus Letter and a Nexus Statement?

It is common to confuse Nexus Letters with nexus statements, but they are slightly different; these include;  

•  A Nexus Letter is a medical document written by a qualified healthcare provider that includes an evidence-based reason for its findings and a medical opinion that supports your claim. Any additional documentation linking your condition to military service is also included. 

• A nexus statement is usually a single-sentence statement included in the Nexus Letter, describing whether the condition is “at least as likely as not” connected to service, with little or no supporting detail. 

• Compared to a nexus statement, a Nexus Letter provides more comprehensive medical reasoning, making it more difficult for the VA to deny your claim. 

Wrapping Up

A Nexus Letter can provide critical evidence When medical records fail to link a veteran’s service to their disability. Veterans can increase their chances of winning VA benefits by working with a qualified Nexus Letter provider, gathering pertinent military and medical records, and correctly submitting their claims. 

How Telemedica Can Support You in Obtaining a Nexus Letter

Understanding the need for a nexus letter for sleep apnea secondary to depression may strengthen your claim. The licensed, trusted professionals at Telemedica can provide you with a nexus letter, paving the way to the benefits you rightfully deserve.   

Medical Evidence Wins VA Claims

Did you know that a lack of medical evidence is the #1 reason VA disability claims are denied?   

Medical evidence is a crucial piece of the puzzle that VA raters consider when reviewing a disability claim. Telemedica provides solutions for veterans looking to bolster their claims through high-quality medical evidence that wins claims. 

Schedule your FREE 20-minute consultation and learn how to get the supporting medical evidence you need to strengthen your claim.