Establishing a nexus between a veteran’s current disability and an in-service event is often the most challenging part of the service connection process for a VA disability claim. Without this link, the Department of Veteran Affairs (VA) will likely deny a veteran’s claim.
This article will provide an actual example of a nexus letter that can be used as a guide for obtaining the VA disability benefits that veterans earned.
What Should a Nexus Letter Include?
The VA requires veterans seeking service connections to meet three criteria. Firstly, they must have a currently diagnosed disability. Secondly, they must demonstrate that the disability was incurred or aggravated by an in-service event, injury, or illness. Finally, they must provide a medical nexus connecting their current disability to the in-service event, injury, or illness.
This opinion should be based on a review of the veteran’s medical records and other relevant evidence and should be supported by scientific evidence and medical literature. The veteran must choose a qualified medical professional knowledgeable in their particular condition and understands the requirements for establishing a nexus for disability purposes. Therefore, the veteran must ensure their letter is formatted as the nexus letter example that’s given and includes all the necessary information to support their claim.
What Elements Must a Nexus Letter Example Contain?
The key to drafting a compelling nexus letter is ensuring that it contains all of the critical elements the VA is expecting so that they can make an informed determination of the veteran’s eligibility for benefits. Here’s what to include:
1. The physician’s credentials are essential in establishing expertise and authority in their field, particularly concerning the veteran’s medical condition.
Credentials may include their medical degree, board certification in a relevant specialty, years of experience in their field, and all pertinent research papers or publications they’ve authored. Their credentials demonstrate to the VA that the physician is a trustworthy source for the opinion they provide in the nexus letter.
2. For the physician’s opinion to carry weight with the VA, it’s important that they’ve thoroughly reviewed the veteran’s medical and military records about their claim.
The medical review allows the physician to comprehensively understand the veteran’s medical history, including any previous diagnoses, treatments, surgeries, and relevant military service-related events or exposures. A reference indicating that the physician has reviewed these records can add credibility to their opinion and demonstrate to the VA that the physician has carefully considered all available information.
3. The physician’s opinion regarding the cause of the veteran’s current diagnosed condition and its relation to their military service is critical to the letter of support.
The physician should clearly state their opinion regarding the causal relationship between the veteran’s condition and their military service. For example, they may say that they believe the veteran’s current condition was caused by exposure to a specific toxin during their military service. This opinion should be based on a thorough review of the veteran’s medical and military records and the physician’s expertise and experience in their field.
4. To support their opinion, the physician should provide a medical rationale explaining the connection between the veteran’s condition and their military service.
The explanation should be clear and concise and give a convincing argument for the physician’s opinion. This rationale should be based on scientific evidence and medical literature and demonstrate how the veteran’s military service contributed to their condition. For example, suppose the veteran has a respiratory illness the physician believes was caused by exposure to a specific chemical agent during military service. In that case, the physician should provide evidence from medical studies and research that supports this connection.
What Should a Doctor Write in a Letter to the VA?
Very specific information must be included with the physician’s letter, as you’ll see in the nexus letter example given below. Meanwhile, here are brief explanations of the information it should contain:
• A physician should start the letter by introducing the veteran and the purpose of the letter. For example, the physician could say: “I am writing this letter of support for John Smith, a U.S. Navy veteran who served from April 1992 to April 1996. Mr. Smith is currently experiencing Parkinson’s Disease and requires support from the VA.”
• The physician should introduce him or herself and provide their credentials and experience, including any affiliation with the VA. For example, the doctor could say: “I am a board-certified neurologist with 14 years of experience treating neurological disorders, including Parkinson’s Disease. I am currently a resident at Florida Hospital Orlando and have worked with several veterans affiliated with the VA.”
• The physician should provide details about his or her clinical relationship with the veteran, including when treatment started and how often the veteran has been seen. For example, the doctor could say: “I’ve been treating Mr. Smith for his Parkinson’s Disease since June 2012, and we’ve met approximately once a month during this period.”
• If the veteran has a mental health diagnosis, provide the DSM-V diagnostic code and format, and note the veteran’s GAF or WHODAS score. Explain the reasons for any score fluctuations and give a range if applicable. For example, physicians could say: “Mr. Smith has a GAF score of 40, indicating significant impairment in his social and occupational functioning due to PTSD.”
• Describe the veteran’s symptoms in detail, including their severity and how long they’ve been experiencing them. Use the DSM-V criteria if applicable and explain how the symptoms are related to the veteran’s diagnosis. For example, physicians could write: “Mr. Smith experiences tremors, stiffness, and balance problems due to his Parkinson’s Disease. He has had these symptoms for the past five years, significantly impacting his ability to perform daily activities such as writing, typing, and feeding himself.”
• Describe how the veteran’s symptoms affect their function, focusing on social and occupational impairments. Provide specific examples of how the symptoms limit the veteran’s ability to function. For instance, a physician could say: “Mr. Smith’s tremors make it difficult for him to maintain steady employment, and he has difficulty participating in social activities due to the embarrassment caused by his symptoms.”
• If the veteran’s disability is not currently service-connected, give an explanation that describes the “nexus” between the veteran’s condition and the event or exposure in-service that caused or exacerbated the disability. Use medical and academic literature to support an opinion of the causal link. For example, doctors might say: “Based on my review of Mr. Smith’s medical records and clinical interview, it’s my opinion that Parkinson’s Disease is at least as likely as not related to his Agent Orange exposure in Vietnam.”
Use the Proper Formatting
The letter should be formatted just like the nexus letter example, and the doctor writing the letter should use the appropriate headers at the top. For example:
Dr. Jane Doe, MD
1234 Medical Lane
Boston, MA 02101
In addition, the doctor should include the following information above the first paragraph of the letter:
Date: January 1, 2021
Reference: [Veteran’s Name]
VA File #: XXXXX
Veteran SSN: XXX-XX-XXXX
Finally, the doctor should sign the letter and include their name and credentials. It’s important to remember that the doctor who writes the nexus letter is a neutral party. As such, their role is to provide an honest medical opinion based on their review of the evidence.
Sample Nexus Letter for Sleep Apnea
[Medical Professional’s Letterhead] [Date]
Subject: Medical history of Mr. Veteran
Reference: C-File # or Social Security Number
To: The Veterans Administration (VA)
I am writing to provide an Independent Medical Expert (IME) nexus opinion for [Veteran’s Name], seeking disability compensation for obstructive sleep apnea related to military service.
As a qualified medical professional with experience in sleep medicine, I’ve reviewed [Veteran’s Name]’s medical records and evaluated them in person. Based on my review and evaluation, I believe that [Veteran’s Name]’s obstructive sleep apnea relates to their military service.
[Veteran’s Name] served in the [Branch of Service] from July 28, 1999, to September 15, 2004, when he was diagnosed with allergic rhinitis and a deviated septum. The veteran’s medical records detailed that he received treatment for these conditions, including medication and nasal sprays.The veteran underwent a sleep study on June 12, 2018, which revealed mild snoring and a moderate form of obstructive sleep apnea. These findings indicate that the veteran’s upper airway is subject to collapse, consistent with the medical literature on the causes of obstructive sleep apnea. The sleep study report also indicated that his obstructive sleep apnea is more likely than not secondary to a nasal obstruction due to allergic rhinitis and deviated septum, which is documented to exist during his military service.
Based on my medical opinion and review of the relevant medical literature, I believe that [Veteran’s Name]’s obstructive sleep apnea is secondary to a nasal obstruction due to allergic rhinitis and deviated septum. Specifically, the research shows that a slight reduction in the diameter of the upper airway can collapse the upper airway during sleep. Nasal breathing is significantly less likely to result in upper airway resistance and obstructive sleep apnea than oral breathing. Given the veteran’s prior diagnoses of allergic rhinitis and a deviated septum, it’s likely that nasal obstruction contributed to the veteran’s obstructive sleep apnea.
Therefore, I opine that it’s more likely than not that [Veteran’s Name]’s obstructive sleep apnea is related to their military service and nasal obstruction due to allergic rhinitis and deviated septum.
Please do not hesitate to contact me with any questions or further information.
Sincerely,
[Medical Professional’s Name] [Medical Professional’s Credentials] [Medical Professional’s Contact Information]