A well-written nexus letter, or nexus statement, is a key component of your veteran’s disability claim. Proving to the VA that your disability is connected to your military service is part of the process.
The absence of a great medical nexus statement is a primary cause of initial claim denial. When you’re fighting for your benefits, we can help you obtain the appropriate expert medical opinion on the nexus issue.“Nexus” means a link or a connection. You must show the VA evidence of the link between your current medical condition and (1) another service-connected condition, or (2) circumstances directly related to your military service.
The VA claims examiner needs to see three pieces of evidence:
- An in-service event (injury, disease, or stressor) that could have caused or aggravated a disease or impairment
- A present-day diagnosis of the existence of the disease or impairment
- A medical opinion linking number 1 with number 2. This is the basis of the nexus letter.
When you can prove all three points above, the VA should concede that your disability is service connected. The VA would then proceed to award a disability rating based on the severity of your service connected disability.
The problem is that veterans’ service medical records, separation documents, and personnel records are often insufficient and don’t clearly show how the veteran’s disability is tied to his or her service.
For example, many conditions get worse as time goes on. You may need to file a claim now for a minor incident sustained during service years ago. Let’s say in 2001 you strained your back carrying heavy packs and weapons, but you “toughed it out” with pain meds and temporary light duty without ever filing a claim. Over the years your back has worsened to the point you cannot work because your spine longer bends and flexes properly. While your impairment was relatively minor 20 years ago, today it’s disabling.
The essential medical opinion linking service-connection to the condition is the Nexus letter.
Who Writes the Nexus Letter?
Choosing the right medical expert is key to successfully arguing VA compensation claims. A nexus letter is written by an independent medical expert in the area of health that is at issue. The expert does not have to be a doctor but must have competent medical training in the field relevant to the veteran’s impairment.
- If cancer is the claimed medical impairment, an oncologist is the VA’s preference.
- If you sustained a bone or skeletal injury, you would seek the opinion of an orthopedic surgeon.
- For PTSD disability claims, the VA will accept the opinions of a psychologist or clinical psychiatrist
Other possible experts include licensed physician’s assistants and nurses. The better trained and better-respected your medical expert is, the more likely the VA is to rule favorably on his or her opinion, so choose carefully.
The author of the nexus letter must verify that all available and pertinent medical records, including military service medical records, were considered. The opinion provides clarity and authentication regarding how your disabling illness or injury is the result of military service. The opinion explains the circumstances that caused or aggravated your symptoms.
While not a requirement, it is advantageous when the author of the nexus letter has recently examined the veteran.
“As Likely As Not”
To determine whether your current impairment is connected to the in-service event, expert opinions are expressed in degrees of likelihood.VA must follow the “Reasonable Doubt Rule.” This rule means that evidence provided by the veteran must only persuade the VA decision-maker that each factual matter is “at least as likely as not” to be true.
VA’s policy is to dispense the law under this broad interpretation, consistent with the facts of the case. If, after considering all evidence in a veteran’s claim, a reasonable doubt arises regarding service origin, the degree of disability or any other point, such doubt will be resolved in favor of the veteran. In other words, any “reasonable doubt” created because of an equal lack of proof on both sides of the argument goes in favor of the veteran.
The medical nexus statement you submit to the VA need only state that it’s “as likely as not” that your current disability and the precipitating service incident are connected. This removes the burden of providing definitive proof from medical experts. CAVC has correlated the reasonable doubt rule to the baseball doctrine that the “tie goes to the runner.” A successful veteran’s claim requires a 50% chance of connectivity.
“More likely than not” would indicate a 51% chance or greater that your disability is service connected. In either case, the expert’s opinion does not have to be conclusive. It just needs to point out whether “it is as least as likely as not” that the condition was caused by an event during service.
While submitting these medical opinions may not automatically grant the claim for service connection, the VA is bound by law to review and assign proper weight to the opinion when making a decision.
Should All Veterans’ Claims Have a Nexus Letter?
In some situations, a medical opinion stating the link is not required.
When Disability Is the Obvious Result of Service: Generally if a veteran’s current disability is an obvious result of an injury that occurred during service (such as missing leg amputated after a service incident), the veteran will not be required to provide a medical opinion proving the link and will be granted veterans benefits. In a case like this, “lay evidence” is sufficient for the VA to make a decision. As long as the disability in question is readily identifiable to someone without medical training, lay evidence will be all that is required for the VA’s favorable ruling.Presumptive Service Connection: If your condition is on the Presumptive List (exposure to Agent Orange, Camp Lejeune water, radiation, Gulf War veterans with unexplained conic illnesses, etc.) or in certain cases the Noise Exposure Listing (for hearing loss and tinnitus), it may automatically be considered service-connected.
Be mindful that, while the VA waives the nexus requirement in these cases, it is in your best interest to be prepared to provide detailed medical opinions in the case that the VA does not make the assumed allowance. Arguing successful veterans claims is almost always more complicated than the VA’s rules might state, so hiring a qualified veterans attorney is a great way to increase the odds of winning your case.
Connecting Secondary Claims
So far, we’ve discussed claims filed for conditions that are directly linked to incurrence during military service.
Nexus statements are also essential for secondary claims, where impairment was caused or made worse by an existing service-connected condition.
- radiculopathy secondary to a back disorder
- depression secondary to cancer
- migraines secondary to PTSD
- arthritis secondary to a shoulder injury
- obesity, hypertension and sleep apnea secondary to bilateral knee injuries
The nexus letter for a secondary claim provides the rationale and basis for how the secondary condition is connected to the service-connected condition.
We Bridge the Gap between Medical Experts and Veterans
We will work vigorously with you to obtain effective linkage statements that will help prove your claim. We can help you find the most qualified professional to prepare your nexus letter. We make sure no inconsistencies occur between your VA claim file and the nexus letter, as discrepancies can result in VA rejection of the nexus letter and claim denial.
We help you overcome various nexus obstacles. Persuasive arguments and additional evidence will often result in VA changing a denial to a grant of benefits. A strong nexus letter may reference medical research and published works on the medical issue under review. Your nexus letter may also be supported by past Board of Veterans’ Appeals decisions to demonstrate precedence in linking similar conditions directly to events, or linking secondary conditions that occur later in the veteran’s life to direct service-connected conditions. Don’t let the lack of a well-written nexus letter be the reason for the denial of VA disability compensation. If you need help, reach out to us.
Marc Whitehead & Associates has extensive experience navigating the appeals process, including appeals with the Board of Veterans’ Appeals (BVA) and the Court of Appeals for Veterans Claims (CAVC).
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