How Medical Evidence Provides a Nexus

A “nexus letter” is a document prepared for a claimant by a medical professional that explicitly connects an in-service event to the current medical condition for which a claimant is seeking compensation. A claimant is not required to submit a nexus letter, but such a letter can make the difference between an award and a denial. A nexus letter can be submitted with an initial application, during claim development, or after an adverse C&P exam. Submitting a properly worded nexus letter as early as possible in the process, however, is good practice.

A nexus letter is especially important in cases where a claimant has not submitted any medical evidence and a C&P examiner concludes that there is no connection between a claimant’s condition and military service. Without a nexus letter, the claim will be denied. Even when a claimant supplies supporting medical evidence with an application, VA raters can and often do choose the opinion of the VA examiner over a private physician’s opinion for many reasons. In such a case, a “nexus letter” from a private physician is necessary to respond to the C&P examiner’s conclusion.

One reason for raters favoring VA examiner’s conclusions regarding a nexus when there are conflicting or unclear medical opinions is that VA examiners are more familiar with the terms that raters look for when deciding a claim. As described above, VA regulations require only that it be “at least as likely as not” that a condition be related to service for an award.

Most medical professionals, however, are not familiar with the VA system or the VA concept of “at least as likely as not.” Physicians are generally familiar with the concept of “medical certainty,” which is a much higher standard than that required by VA. As a result, private physicians may apply the wrong standard if the VA terms are not explained to them. This is why it’s important to have strong legal and medical advocate as part of your team when developing a nexus. To learn more contact the Vet Defender by scheduling an appointment at this link: Schedule an Appointment.