NEXUS Letter

Topics:

What is a NEXUS Letter?
Which Claims Require a NEXUS Letter?
The Four Elements of a NEXUS Letter
Obtaining a NEXUS Letter

What is a NEXUS Letter?

A “nexus” is a link or connection between two or more things. Thus the purpose of a NEXUS letter is to clearly connect a veteran’s current medical condition to another service-connected condition or to circumstances directly related to military service.

NEXUS letters are letters from a veteran’s current physician(s) stating their medical opinion regarding the service-connection of a veteran’s condition(s).

NEXUS letters are essential for any condition on a VA Disability Claim that is not automatically considered service-connected because 1.) there is ample evidence that it occurred during the veteran’s service or 2.) it is on the VA Presumptive List.

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Which Claims Require a NEXUS Letter?

All secondary conditions or conditions caused by military exposure/circumstances not included on the Presumptive List benefit from a NEXUS letter supporting the claim.

The VA is required by law to have clear and definite proof that a condition was caused by military service and no other cause before they can provide disability benefits. It is the veteran’s responsibility to provide that proof. No proof, no benefits. A NEXUS letter is a strong form of proof that can bridge gaps in a condition’s link to military service.

For secondary conditions (conditions caused by other conditions), a NEXUS letter must clearly detail how the current condition was caused by the original.

For example, let’s say while in service a veteran broke a bone in their left leg that never healed properly. They separated from the military and the broken bone was determined service-connected and rated 10% by the VA. Ten years later, the veteran is diagnosed with degenerative arthritis in the left knee. Because there is plentiful medical studies to show that injuries in a limb can cause wear and tear on the joints in that limb, it is medically logical that the arthritis was caused by the broken bone. In order to “prove” this, however, the veteran needs their physician to write a NEXUS letter detailing this connection.

A NEXUS Letter shows a clear connection between conditions, like PTSD, and the veteran's military service.

In cases of mental disorders, like PTSD, a NEXUS letter can help connect the disorder to an event or circumstance related to military service that caused the disorder. It’s important to be able to show that the military service was the main cause of the disorder, and a clear NEXUS detailing the circumstances that triggered the symptoms will be crucial if minimal records exist of the condition during service.

NEXUS letters can be used similarly for conditions that develop more than a year after separation but were caused by exposure to chemicals, noise, medical treatments, or other circumstances in the military. If a condition is on the Presumptive List (exposure to radiation, Agent Orange, Camp Lejeune water, etc.) or the Noise Exposure Listing (for hearing loss and tinnitus), it is automatically considered service-connected. If not, it is the veterans job to prove the connection, and a NEXUS letter will greatly strengthen your case.

For example, let’s say a veteran worked in a laboratory while in the military. During this time, the veteran was exposed to ____amounts of _______ chemical for ________ years/months. Fifteen years after separation, the veteran develops cancer. The veteran’s exposure is not on the Presumptive List, so it is their job to provide evidence that similar types of exposure to the same chemical is known to cause that particular type of cancer.

In these complex cases, the veteran needs to submit all of the following:

  • Evidence of the amount, length, and type of exposure that they experienced in the military
  • Evidence of the current diagnosis
  • Any medical research they can find showing that similar exposure causes the same diagnosis
  • A NEXUS letter from the physician stating their opinion that the exposure caused the diagnosis in this particular case

In the majority of these cases, there isn’t enough medical research to always support a claim. Under such circumstances, the only way to win a claim is to have very strong NEXUS letters.

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The Four Elements of a NEXUS Letter

Regardless of the type of claim, a NEXUS letter must contain four vital elements:

  1. The physician’s credentials, particularly ones that make them a trustworthy source for the following opinion (i.e. a cardiologist talking about a heart condition, etc.)
  2. A reference indicating that the physician composing the letter has thoroughly reviewed the veteran’s medical records and military records that pertain to the claim
  3. The physician’s opinion regarding the cause of the current diagnosed condition and its relation to the veteran’s military service
  4. Medical rationale that fully supports the physician’s opinion

Check out our Sample NEXUS Letter.

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Obtaining a NEXUS Letter

In more straightforward cases, a single NEXUS letter from a strong source (a specialist in the area questioned) will be enough. However, on more complex cases, particularly ones without enough medical studies or evidence to support the connection, multiple NEXUS letters from different physicians could be beneficial. The more specialists that agree, the less room the VA has to disagree.

It is the veteran’s responsibility to do the ground work and obtain these NEXUS letters. The physicians writing them do NOT have to be related to the VA, however, ones familiar with the disability system may be more willing to write the letter.

It can take some work to find a physician with the right specialty and knowledge of your condition who would be willing to write a NEXUS letter. It’s best to start with the physicians that know you and your conditions the best. If they refuse to help, you may have to branch out and see others in your area. There is, unfortunately, not a database of doctors ready and willing to help with NEXUS letters.

If your doctor is hesitant, you might help them out by drafting one from our sample NEXUS letter that they can review, adjust, and sign. Saving your doctor time and headache is always a solid way to get on their good side.

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FAQs

What is a NEXUS Letter?

A NEXUS Letter is a letter from your physician detailing the connection between your current conditions and your military service. The connection could be directly to a military event or circumstance, or to another medical condition that occurred in service.

Do I need a NEXUS Letter?

If you have strong evidence that your conditions are service-connected, then you probably do not need a NEXUS letter. You definitely need a letter, however, if you are trying to prove that your condition is secondary to another service-connected condition or if you do not have strong proof of service-connection.

Who should write my letter?

The physician who knows your current conditions the best should write your letter. Their opinion will hold the most sway since they thoroughly understand your conditions and history.

What if my doctor won't write one?

Often civilian physicians are a bit intimidated by the idea of writing a NEXUS letter simply because they are unfamiliar with the disability system. The best option after you meet with your physician is to send them a letter already written for them that they can then adjust as needed and sign. This helps them feel more confident and diminishes the amount of work they have to put in. If your physician still won't write the letter, you may need to seek out another physician.

When should I submit my letter?

A NEXUS letter is just like any other proof you may have for a claim. As such, it is very important to submit it right at the beginning along with your claim. Submitting it later could result in it not being considered or delaying your claim. If you obtained the letter after your claim was denied, you can submit it as new evidence along with your appeal.

What should my letter say?

Check out our sample letter for full details on the contents, but briefly, it should contain the doctor's name and credentials, the diagnosis and history of the condition, details on how the condition is connected to your military service, and a clear statement that the condition is 'more likely than not' the result of _________.

Can I submit more than one letter?

Yes, if you have multiple medical professionals who are familiar with your conditions, you can submit a letter from each of them. Multiple opinions in your favor definitely strengthen your case, but are not always essential.

What if my claim is still denied?

While NEXUS Letters can be helpful, they are not guarantees that the VA will grant your claim. If there is strong evidence that the condition could have developed in a way unrelated to your military service, then there simply may not be enough evidence in your favor. You could always try to appeal, submitting additional letters from other physicians along with evidence of medical research that support your claim.

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