By Larry Dandridge
Editor’s note: This article is the first in a series of three.
My last three articles explained Lay Witness Statements (statements by a person who is not a trained professional) and how veterans can use them to support their claims for service-connected disability compensation, Individual Unemployment (IU), and other claims with the VA. Lay Witness Statements can provide powerful proof that a service-connected wound, injury, illness, HAZMAT Exposure/injury, or traumatic event caused, contributed to, or exacerbated (worsened) a disability.
This article, along with the next two, will discuss nexus letters.
What does nexus mean?
Merriam-Webster dictionary defines “nexus” as a noun, meaning a connection or link between two things.
Send all evidence supporting your claim
Sending all the supporting evidence a veteran can muster will help the VA process veterans’ claims quickly. If veterans do send “all” of their evidence, including supporting statements from lay witnesses and nexus letters from qualified medical professionals, the probability of the claim being approved is higher. The VA webpage, “How to File a VA Disability Claim” (https://bit.ly/3wYGMRJ), encourages veterans to submit all supporting documents, including a nexus letter if applicable, along with their claim.
According to the VA’s webpage, “The Claim Process After You File Your Claim,” the average number of days the VA takes to complete disability-related claims in March 2025 was 135 days.
Causal connection between military service and disability
In connection with a claim for VA disability compensation, a nexus letter is a formal medical opinion establishing a connection between your disability and your military service. In other words, a nexus letter is a crucial medical document that establishes a connection between a veteran’s disability and their military service.
For veterans filing a claim with the VA, a nexus letter is from a qualified medical doctor (MDs and ODs and over 80 specialists including psychiatrists), psychologist (Ph.D. and PsyD), physician’s assistant (PA), nurse practitioner (NP), physical therapist (PT), occupational therapist (OT), speech therapist (ST), chiropractor (DCs are not a medical doctors but have a doctoral degree focused on treating disorders of the musculoskeletal and nervous systems), dietitian, and other specialists who are trained and licensed to diagnose and treat.
When should a nexus letter be submitted?
Although the VA does not require a nexus letter with a claim for military service-connected disability compensation, a supporting letter from a physician greatly increases the chance that the claim will be approved. A nexus letter may not be needed in the following situations:
1. The veteran’s condition is on the VA’s list of presumptive conditions for service connection. Learn more about presumptive conditions at:
- The VA “The PACT Act and your VA benefits” webpage (https://bit.ly/43srfKr). Gulf War era and post-9/11 Veteran eligibility, and Vietnam era Veteran eligibility.
- The VA webpage “Exposure to hazardous chemicals and materials,” https://bit.ly/3Rrz3E8 (Agent orange, Asbestos, Birth Defects/Spina Bifida, Burn Pits, Mustard Gas or Lewisite, Contaminated Water/Camp Lejune, Gulf War Illness SW Asia, Gulf War Illness Afghanistan, Project 112 or Project SHAD, and Radiation Exposure.
- The VA’s “Public Health (Military exposures)” webpage and newsletter (https://bit.ly/3YHv2kz).
- The VA webpage and Public Health, “Agent Orange Newsletter 2024” (https://bit.ly/4dfnPy1).
- The VA webpage and Public Health newsletter “Military exposures & your health – Winter Issue 15” (https://bit.ly/4j6yA7h).
- The VA webpage “Camp Lejeune water contamination health issues” (https://bit.ly/45F0LUi).
- The VA webpage “Public Health (Environmental health registry evaluation for veterans” (https://bit.ly/457JLcl).
- VA Fact Sheet “Presumptive conditions” (https://bit.ly/3LeLSk4).
2. Your condition is in your military medical records, and your service treatment records cover your condition.
If your disabling condition is not on the VA’s Presumptive List, is not in the veteran’s military medical records, and the veteran’s service treatment records do not cover their claimed condition, the veteran should do his or her best to get one or more nexus letters from a military, VA, or civilian medical doctor or specialist to support their claim. A nexus letter is crucial for establishing a service connection, particularly if the veteran does not receive a diagnosis until after their military service.
What should your doctor or medical specialist include in a nexus letter?
A nexus letter must be based on a review of the veteran’s military medical records, VA medical records, civilian medical records, physical examination results, other relevant information, and any required diagnostic tests. The letter should be factual, to the point, and contain specific language that connects the veteran’s disability to his or her time in service. The letter should provide the doctor’s (or specialist’s) opinion regarding the likelihood that the veteran’s disability is service-connected. The doctor should choose a degree of likelihood of either “At least as likely as not,” “More likely than not,” or “Highly likely.” The doctor may reinforce their opinion with data or facts from medical journals, pictures, other records, or literature.
How to get a nexus letter
Before meeting with your doctor, ask your VA-accredited Veterans Service Officer (VSO) to help you determine if you need a nexus letter. If you need a nexus letter, assemble a copy of your evidence and supporting documents (list of wounds-injuries-traumas-conditions-symptoms, list of medications, list of past treatments, DD214, military medical record, VA medical record, civilian medical record, lay witness statements, pictures, etc.) to show to the doctor or other medical specialist when you meet with them.
Meet with the doctor who is treating you for your service-connected wound, injury, illness, condition, trauma, burn, scar, HAZMAT injury/condition, or disability. Ensure that they are a specialist in your specific disability. You may need to ask your primary care physician for a referral to a specialist. You can request a nexus letter from a military doctor, a VA doctor, a civilian doctor, or a medical specialist.
If possible, get more than one medical expert to write a nexus letter in support of your claim. For example, when this writer filed for service connection for my Vietnam War back injuries and resulting disabilities, I got strong nexus letters from my Primary Care Physician, Orthopedic Surgeon, PhD. Physical Therapist, Pain Management Doctor, and my Chiropractor — and my claims were accurately approved.
Continued next week.
Larry Dandridge is a Vietnam War wounded warrior, a combat and service-connected 100% disabled veteran, an ex-Enlisted Infantryman, an ex-Warrant Officer Pilot, and a retired Lt. Colonel. His over 250 articles on veterans’ benefits, leadership, logistics, hospice, law enforcement, and aeronautics have been published in over 20 magazines and newspapers in the USA, Germany, and England. Larry is a former Veterans Service Officer, a Patient Adviser at his local VA Hospital, a Fisher House Charleston Goodwill Ambassador, and the past Vice President for Veteran Affairs for his local Association of the US Army (AUSA) and Military Officer Association Chapters. He is currently the VFW Post 7378 Service Officer, the author of the award-winning and popular (over 250 five-star reviews) Blades of Thunder (Book One), and a contributing freelance writer with the Island News. Contact him at LDandridge@earthlink.net or 843-276-7164.
