A nexus opinion refers to a legal or medical determination that establishes a connection between two elements, typically in the context of disability claims, workers’ compensation, or legal cases.
What does this mean for us when we’re trying to improve a VA disability claim?
A nexus opinion in this context is a medical statement from a qualified doctor linking a veteran’s current disability to their military service.
When providing a nexus opinion to the VA, we do so in the form of a nexus letter.
Where to Get a Nexus Letter:
Your Private Physician or Specialist
- If you are receiving treatment from a private doctor (outside the VA), you can ask them to write a nexus letter.
- Ensure the doctor understands VA disability requirements and uses the appropriate medical language (e.g., “at least as likely as not”).
VA Doctors (Limited Availability)
- Some VA doctors may be willing to provide a nexus opinion, but many avoid doing so due to VA policies. It’s best to ask politely if they would support your claim.
Online Services
- Some companies and medical professionals offer paid services to review records and provide a professional nexus opinion.
- Costs range from $500 up to thousands. We recommend shopping around for the best price and service combination. We’ve already done that for you, but it’s always good to do your own research
- Examples include:
- Valor 4 Vet
- Telemedica
- Xterra Health (our preferred partner)
Key Components of a Strong Nexus Opinion:
- A clear statement of the connection (causation)
- Medical evidence or rationale supporting the opinion
- A professional opinion expressed with a degree of certainty (e.g., “more likely than not” or “at least as likely as not”)
When to Seek Out a Nexus Letter:
1. When There Is No Automatic Service Connection
The VA grants service connection automatically for some conditions (like Agent Orange exposure-related illnesses), but for others, you need to prove the link. A nexus letter helps in cases where this connection is not obvious.
Example: You develop arthritis years after discharge but have no direct service treatment records for it. A doctor can write a nexus letter linking your arthritis to repeated joint stress during service.
2. For Secondary Service Connection Claims
You may have a condition that is not directly service-connected but was caused or worsened by another already service-connected disability.
Example:
- You have a service-connected knee injury, and over time, you develop back pain from walking with an altered gait.
- A nexus letter from a doctor can explain how your knee condition caused or worsened your back pain, making it eligible for secondary service connection.
3. When There Are Gaps in Medical Records
If there is a long gap between your military service and the diagnosis of your condition, the VA may deny your claim due to a “lack of continuity of symptoms.” A nexus letter can help bridge this gap.
Example: You start experiencing hearing loss 10 years after military service, but you worked in artillery or aviation while enlisted. A medical expert can confirm your hearing loss is likely due to military noise exposure.
4. When the VA Denies Your Claim Due to Lack of Medical Evidence
If your initial VA disability claim was denied because the VA said there was “no link” between your disability and service, a nexus letter can provide the medical evidence needed to support your appeal.
Example:
- You have PTSD, but the VA says there’s “not enough proof” that your condition is tied to your military service.
- A psychiatrist or psychologist can write a nexus letter confirming that your PTSD symptoms are linked to combat experiences or military trauma.
5. For Conditions Related to Toxic Exposure (Burn Pits, Agent Orange, etc.)
Some illnesses are linked to military exposures, but you still need a medical opinion to prove the connection if your condition is not on the VA’s presumptive list.
Example:
- You were exposed to burn pits in Iraq and later developed respiratory issues.
- A nexus letter from a lung specialist can help prove that exposure to toxic fumes caused your condition.
6. When Seeking a Higher Disability Rating (Aggravation Claims)
If your condition has worsened over time due to military-related stress or service-connected conditions, a nexus letter can help.
Example:
- You have service-connected depression, and it has worsened due to chronic pain from another service-connected injury.
- A mental health professional can provide a nexus letter explaining how your worsening depression is linked to your physical condition.
7. For Conditions Diagnosed After Discharge
If you were diagnosed after leaving the military, you might still be eligible for benefits, but you need a nexus letter to show the connection.
Example:
- You developed hypertension five years after leaving the service but had high blood pressure readings while in the military.
- A doctor can write a nexus letter linking your current hypertension to those early signs during active duty.
8. When Using Lay Evidence to Support Your Claim
If your claim relies on buddy statements or personal testimony (lay evidence) rather than official service records, a nexus letter from a medical professional can strengthen your case.
Example:
- Your medical records don’t show documentation of your migraines during service, but a fellow soldier confirms you suffered from them.
- A doctor can write a nexus letter confirming that migraines are consistent with your service experiences.
Conclusion
A nexus letter is one of the strongest pieces of evidence you can submit in a VA claim, especially when the VA requires proof of a service connection. If any of the above situations apply to your claim, getting a qualified medical provider to write a nexus letter can increase your chances of approval.