Doctor Holding a Nexus LetterTo win a service connection for your disability, you must be able to accomplish three key things:

  • Provide proof you have a currently diagnosed disability
  • Document an in-service event, injury, or illness
  • Show a medical nexus that links your disability with your in-service event, injury, or illness

If you can’t show that your disability is linked to a specific in-service event, injury, or illness, your application for VA disability benefits can be denied regardless of the severity of your condition. The only exception to this rule would be if your condition qualifies for a presumptive service connection.

A nexus letter helps you establish the medical nexus for your condition. This letter is sometimes referred to as an independent medical opinion (IMO).

Finding a Professional to Prepare Your Nexus Letter

Not all nexus letters will carry the same weight. A strong nexus letter should be written by a licensed professional with experience treating patients suffering from your specific condition. Although you are technically allowed to submit a letter written by a nurse practitioner, a more credentialed expert is preferable. At a minimum, you want a professional who is a licensed physician’s assistant.

Doctors from the VA can’t write nexus letters. Since they are employed by the VA, they are not considered independent medical experts.

If you are not sure if a provider is qualified to prepare your nexus letter, it is appropriate to ask for references from previous Veteran clients. While it’s impossible to guarantee a nexus letter will get your claim for benefits approved, you want to obtain a letter from someone who has experience working with the VA and understands what is required to establish a service connection.

When you are represented by an experienced Veterans benefits attorney, your attorney can help you find the most qualified professional to prepare your nexus letter.

Criteria for an Effective Nexus Letter

Nexus letters can vary widely in length. Some letters are only one page, but others could be as long as 25 pages. Regardless of length, an effective letter should:

  • Provide an opinion based on your history before and after military service and refer to your service medical and personnel records
  • Cite relevant medical research and/or case law
  • Clearly state that it is “at least as likely as not” that your condition is caused by your military service
  • Be signed, dated, and list the writer’s professional credentials

Please note that it is very important that the doctor writing your nexus letter review your entire VA claims file. Inconsistencies can result in a dismissal of the nexus letter and a denial of your benefits.


Unfortunately, the cost of a nexus letter can vary widely—ranging from several hundred to several thousand dollars based on the skills and experience of the writer. In most cases, there is an additional charge for every condition that must be discussed in the letter.

While Veterans benefits attorneys accept a percentage of past-due benefits as payment for their services, a healthcare professional writing a medical nexus letter will expect to be paid upfront.

How Your Nexus Letter Is Used

The nexus letter prepared by your healthcare provider will be reviewed by the C&P examiner, as well as the VA Rating Official who makes the final disability decision. Because it carries such high weight, the nexus letter is often referred to as a “linchpin” piece of evidence for your claim.

Let Us Help You Get the Benefits You Deserve

The process of applying for Veterans disability benefits can be quite complex, and the system is notoriously difficult to manage while you’re experiencing serious health challenges. However, you don’t have to go through the process alone.

The office of Sean Kendall, Attorney-at-Law, has been helping Veterans access the VA disability benefits they earned in service of their country for more than 20 years. We have extensive experience navigating the appeals process, including appeals with the Board of Veterans’ Appeals (BVA) and the Court of Appeals for Veterans Claims (CAVC). We are able to represent you even if you were previously represented by another attorney or a Veterans Service Organization (VSO) representative. Contact our office today to schedule a free, no-obligation initial consultation.