A nexus letter, also known as an Independent Medical Opinion (IMO), is a crucial piece of evidence in VA disability claims. It’s a written statement from a qualified medical professional that links your current disability to your military service. A strong nexus letter can significantly increase your chances of a successful claim. These letters provide expert opinions establishing a causal link, or nexus, between your military service and your current medical condition. Without this connection, it can be challenging to prove your disability is service-connected.
This article provides 21 sample nexus letters. These samples are for informational purposes only and should not be used verbatim. It is imperative that you work with your own medical professional to obtain a personalized nexus letter tailored to your specific medical history and service record. These samples provide examples of the language and structure used in effective nexus letters, covering various disabilities and connection types.
Nexus Letter Samples
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Sample 1: General Nexus Letter Example
[Date]
[Medical Professional’s Name]
[Medical Professional’s Credentials]
[Address]Department of Veterans Affairs
[Address]RE: Veteran [Veteran’s Name], VA Claim Number [VA Claim Number]
To Whom It May Concern:
I am writing this letter on behalf of my patient, Veteran [Veteran’s Name]. I have reviewed [his/her] medical records and service records, and have conducted a thorough medical examination on [date of examination].
Based on my professional medical opinion, it is at least as likely as not that [Veteran’s Diagnosis] is directly related to [specific event, injury, or exposure during military service] during [his/her] military service. This opinion is based on the following factors:
- [Specific medical findings]
- [Relevant scientific literature supporting the connection]
- [Temporal relationship between the service event and the onset of symptoms]
Therefore, it is my professional medical opinion that a nexus exists between [Veteran’s Diagnosis] and [his/her] military service.
Sincerely,
[Medical Professional’s Signature]
[Medical Professional’s Typed Name] -
Sample 2: PTSD Nexus Letter
[Date]
To Whom It May Concern:I am writing to provide my professional medical opinion regarding Veteran [Veteran’s Name], whose VA claim number is [VA Claim Number]. I have been treating Veteran [Veteran’s Name] since [Date] for symptoms consistent with Post-Traumatic Stress Disorder (PTSD).
After reviewing [his/her] service records and conducting numerous clinical interviews, it is my professional medical opinion, to a degree of medical probability, that Veteran [Veteran’s Name]’s current PTSD diagnosis is directly related to [specific traumatic event or events experienced during military service]. Specifically, the onset of symptoms, including [list specific symptoms like nightmares, hypervigilance, anxiety, depression], directly correlate with the time frame following the aforementioned traumatic event.
The DSM-5 criteria for PTSD are clearly met in this case, and the nexus to [his/her] military service is strongly supported by the chronological relationship and the nature of the traumatic experiences.
Sincerely,
[Medical Professional’s Name] -
Sample 3: Back Pain Nexus Letter
[Date]
To Whom It May Concern:This letter concerns my patient, Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], who I have been treating for chronic back pain since [Date].
Having reviewed [his/her] military records and conducted thorough physical examinations, it is my professional medical opinion that Veteran [Veteran’s Name]‘s chronic back pain is at least as likely as not (50% probability or higher) directly related to the strenuous physical demands of [his/her] military service, specifically [describe specific duties that likely contributed to the back pain, e.g., heavy lifting, prolonged standing, parachute jumps].
The physical stress experienced during [his/her] service, coupled with the absence of pre-existing back problems prior to enlistment, strongly suggests a service connection for [his/her] current condition. Diagnostic imaging reveals [describe relevant findings from X-rays, MRIs, etc., if available], further supporting the diagnosis and the connection to the physical stressors endured during service.
Sincerely,
[Medical Professional’s Name] -
Sample 4: Tinnitus Nexus Letter
[Date]
To Whom It May Concern:I am writing on behalf of Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], regarding [his/her] claim for tinnitus. I have been [his/her] audiologist/physician since [Date].
Based on my evaluation of [his/her] medical and service records, and after conducting audiometric testing, it is my professional medical opinion that Veteran [Veteran’s Name]‘s tinnitus is more likely than not (a 50% or greater probability) directly related to noise exposure experienced during [his/her] military service.
[He/She] reports being exposed to loud noises from [specifically list sources of noise exposure, e.g., gunfire, heavy machinery, aircraft engines] during [his/her] deployment to [Location] and during training exercises at [Location]. Audiological testing confirms the presence of [describe findings, e.g., high-frequency hearing loss], which is consistent with noise-induced hearing damage and a known cause of tinnitus.
Sincerely,
[Medical Professional’s Name] -
Sample 5: Knee Injury Nexus Letter
[Date]
To Whom It May Concern:This letter addresses the VA claim of Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], concerning a knee injury. I have reviewed [his/her] medical records and conducted a physical examination on [Date].
It is my professional medical opinion, with a reasonable degree of medical certainty, that Veteran [Veteran’s Name]‘s current knee condition, specifically [diagnosis, e.g., torn meniscus, osteoarthritis], is directly and proximately caused by an injury sustained during [his/her] military service.
According to [his/her] service records and medical history, [he/she] suffered a [describe the injury event, e.g., fall during training, direct blow to the knee during a game, twisting injury while carrying heavy equipment] on [Date] while serving in [Location/Unit]. The onset of knee pain and limited range of motion began immediately following this incident. The current diagnosis is consistent with the type of injury sustained during that event.
Sincerely,
[Medical Professional’s Name] -
Sample 6: Migraine Nexus Letter
[Date]
To Whom It May Concern:I am writing to provide my medical opinion regarding Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], whom I have been treating for migraines since [Date].
After reviewing [his/her] service records and conducting a comprehensive neurological examination, it is my professional medical opinion that Veteran [Veteran’s Name]‘s migraines are at least as likely as not (50% probability or higher) related to stressors and exposures experienced during [his/her] military service.
[He/She] reports the onset of frequent and severe migraines began shortly after [describe specific events or exposures during service that could trigger migraines, e.g., exposure to loud noises, sleep deprivation, stress from combat deployments, exposure to chemicals]. While the exact etiology of migraines is often multifactorial, the temporal relationship between these service-related events and the onset of migraines strongly suggests a causal connection.
Sincerely,
[Medical Professional’s Name] -
Sample 7: Sleep Apnea Nexus Letter
[Date]
To Whom It May Concern:This letter concerns my patient, Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], who has been diagnosed with sleep apnea.
Based on my review of [his/her] medical records, service records, and the results of a sleep study conducted on [Date], it is my professional medical opinion, to a reasonable degree of medical certainty, that Veteran [Veteran’s Name]‘s sleep apnea is secondary to [his/her] service-connected condition of [Name of Service-Connected Condition, e.g., PTSD, Obesity caused by service].
Specifically, [Explain the connection between the service-connected condition and sleep apnea. For example, if sleep apnea is secondary to PTSD, explain how PTSD-related anxiety and hyperarousal can disrupt sleep patterns and contribute to the development of sleep apnea. If secondary to obesity, explain how the weight gain can obstruct airways.].
Sincerely,
[Medical Professional’s Name] -
Sample 8: Scar Nexus Letter
[Date]
To Whom It May Concern:This letter addresses the claim of Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], regarding a scar.
After reviewing [his/her] service records and conducting a physical examination, it is my professional medical opinion that the scar located on [location of scar] is a direct result of an injury sustained during [his/her] military service.
According to [his/her] service records, [he/she] sustained a [describe the injury that caused the scar, e.g., laceration, burn, surgical incision] on [Date] while serving in [Location/Unit]. The scar is consistent with the type of injury reported and is a permanent disfigurement. [Optionally, describe the characteristics of the scar, e.g., size, shape, color, presence of keloid formation.]
Sincerely,
[Medical Professional’s Name] -
Sample 9: Arthritis Nexus Letter
[Date]
To Whom It May Concern:I am writing on behalf of Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], regarding [his/her] claim for arthritis.
Based on my review of [his/her] medical and service records, and after conducting a physical examination, it is my professional medical opinion that Veteran [Veteran’s Name]‘s arthritis in [specify the joint, e.g., knee, hip, back] is at least as likely as not (50% probability or higher) related to the physical demands and/or a specific injury sustained during [his/her] military service.
[He/She] reports [describe specific events during service that could have contributed to the arthritis, e.g., repetitive heavy lifting, strenuous physical training, a specific injury to the joint]. The development of arthritis in this joint is consistent with the type of stress and trauma experienced during [his/her] service.
Sincerely,
[Medical Professional’s Name] -
Sample 10: Radiculopathy Nexus Letter
[Date]
To Whom It May Concern:This letter concerns my patient, Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], who has been diagnosed with radiculopathy.
Based on my review of [his/her] medical records, service records, and a neurological examination, it is my professional medical opinion, to a reasonable degree of medical certainty, that Veteran [Veteran’s Name]‘s radiculopathy is secondary to [his/her] service-connected condition of [Name of Service-Connected Condition, e.g., back injury, spinal stenosis].
[Explain the connection. For example: “The radiculopathy, characterized by pain and numbness radiating down the leg, is a direct result of nerve compression caused by the spinal stenosis, which is service-connected. The stenosis itself is a consequence of degenerative changes resulting from the back injury sustained during military service.”]
Sincerely,
[Medical Professional’s Name] -
Sample 11: GERD (Gastroesophageal Reflux Disease) Nexus Letter
[Date]
To Whom It May Concern:I am writing on behalf of Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], regarding [his/her] claim for GERD.
After reviewing [his/her] medical and service records, it is my professional medical opinion that Veteran [Veteran’s Name]‘s GERD is at least as likely as not (50% probability or higher) related to [his/her] military service, specifically secondary to [his/her] service-connected condition of [Name of Service-Connected Condition, e.g., PTSD, use of certain medications prescribed for service-connected conditions].
[Explain the connection. For example: “The GERD is likely exacerbated by the stress and anxiety associated with PTSD. Furthermore, the medications prescribed for PTSD can have side effects that contribute to GERD.”]
Sincerely,
[Medical Professional’s Name] -
Sample 12: Plantar Fasciitis Nexus Letter
[Date]
To Whom It May Concern:This letter pertains to Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], and [his/her] claim for plantar fasciitis.
Based on my examination and review of [his/her] medical and service records, it is my professional medical opinion, with a reasonable degree of medical certainty, that Veteran [Veteran’s Name]‘s plantar fasciitis is directly related to the physical demands of [his/her] military service.
[He/She] reports prolonged periods of standing and walking, often while carrying heavy loads, during [his/her] service in [Location/Unit]. This type of activity places significant stress on the plantar fascia, increasing the risk of inflammation and injury.
Sincerely,
[Medical Professional’s Name] -
Sample 13: Headaches Nexus Letter
[Date]
To Whom It May Concern:I am writing to provide my medical opinion regarding Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], whom I have been treating for chronic headaches.
After reviewing [his/her] service records and conducting a neurological examination, it is my professional medical opinion that Veteran [Veteran’s Name]‘s headaches are at least as likely as not related to [his/her] military service, specifically secondary to [his/her] service-connected condition of [Name of Service-Connected Condition, e.g., Traumatic Brain Injury (TBI), PTSD].
[Explain the connection. For example, if secondary to TBI: “The headaches are a common sequela of TBI. The TBI sustained during military service has likely damaged neural pathways, leading to chronic headaches.” If secondary to PTSD: “The chronic stress and anxiety associated with PTSD can trigger tension headaches and migraines.”]
Sincerely,
[Medical Professional’s Name] -
Sample 14: Shoulder Injury Nexus Letter
[Date]
To Whom It May Concern:This letter addresses the VA claim of Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], concerning a shoulder injury.
It is my professional medical opinion, with a reasonable degree of medical certainty, that Veteran [Veteran’s Name]‘s current shoulder condition, specifically [diagnosis, e.g., rotator cuff tear, impingement syndrome], is directly and proximately caused by an injury sustained during [his/her] military service.
According to [his/her] service records and medical history, [he/she] sustained a [describe the injury event, e.g., fall, overuse injury from repetitive tasks, lifting heavy objects] on [Date] while serving in [Location/Unit]. The onset of shoulder pain and limited range of motion began shortly after this incident.
Sincerely,
[Medical Professional’s Name] -
Sample 15: IBS (Irritable Bowel Syndrome) Nexus Letter
[Date]
To Whom It May Concern:I am writing on behalf of Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], regarding [his/her] claim for IBS.
After reviewing [his/her] medical and service records, it is my professional medical opinion that Veteran [Veteran’s Name]‘s IBS is at least as likely as not (50% probability or higher) related to [his/her] military service, potentially secondary to [his/her] service-connected condition of [Name of Service-Connected Condition, e.g., PTSD, exposure to certain chemicals].
[Explain the connection. For example: “The chronic stress and anxiety associated with PTSD can disrupt the gut microbiome and contribute to the development of IBS. Additionally, exposure to certain chemicals during military service has been linked to digestive disorders.”]
Sincerely,
[Medical Professional’s Name] -
Sample 16: Peripheral Neuropathy Nexus Letter
[Date]
To Whom It May Concern:This letter concerns my patient, Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], who has been diagnosed with peripheral neuropathy.
Based on my review of [his/her] medical records, service records, and a neurological examination, it is my professional medical opinion, to a reasonable degree of medical certainty, that Veteran [Veteran’s Name]‘s peripheral neuropathy is related to [his/her] military service, specifically due to [describe the specific cause, e.g., exposure to Agent Orange, repetitive stress injury, secondary to diabetes caused by service].
[Provide specific details. If Agent Orange exposure is claimed, state: “Given the Veteran’s documented presence in areas where Agent Orange was used, and the established link between Agent Orange exposure and peripheral neuropathy, it is my opinion that the Veteran’s peripheral neuropathy is at least as likely as not related to this exposure.” If a repetitive stress injury is claimed, detail the specific duties that caused the injury.]
Sincerely,
[Medical Professional’s Name] -
Sample 17: Asthma Nexus Letter
[Date]
To Whom It May Concern:I am writing on behalf of Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], regarding [his/her] claim for asthma.
After reviewing [his/her] medical and service records, it is my professional medical opinion that Veteran [Veteran’s Name]‘s asthma is at least as likely as not (50% probability or higher) related to [his/her] military service, specifically due to [describe the specific cause, e.g., exposure to dust, fumes, or other irritants during deployment].
[Provide specific details. For example: “During the Veteran’s deployment to [Location], they were exposed to high levels of dust and particulate matter, which is known to trigger or exacerbate asthma. The onset of the Veteran’s asthma symptoms coincided with this deployment.”]
Sincerely,
[Medical Professional’s Name] -
Sample 18: Hearing Loss Nexus Letter
[Date]
To Whom It May Concern:This letter concerns my patient, Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], regarding [his/her] claim for hearing loss. I am an audiologist and have evaluated [his/her] hearing.
Based on my audiometric testing and review of [his/her] service records, it is my professional medical opinion that Veteran [Veteran’s Name]‘s hearing loss is directly related to noise exposure during [his/her] military service.
The Veteran reports significant exposure to loud noises during [his/her] service, including [specific examples, e.g., gunfire, explosions, aircraft engines]. Audiometric testing reveals [describe the type of hearing loss, e.g., high-frequency sensorineural hearing loss], which is consistent with noise-induced hearing loss.
Sincerely,
[Medical Professional’s Name] -
Sample 19: Degenerative Disc Disease Nexus Letter
[Date]
To Whom It May Concern:I am writing to provide my medical opinion regarding Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], whom I have been treating for degenerative disc disease (DDD).
After reviewing [his/her] service records and conducting a comprehensive musculoskeletal examination, it is my professional medical opinion that Veteran [Veteran’s Name]‘s DDD is at least as likely as not related to the cumulative effects of physical stress and strain experienced during [his/her] military service.
[He/She] reports years of heavy lifting, repetitive bending, and exposure to whole-body vibration while serving as a [job title] in the [branch of service]. These activities place significant stress on the spine and can accelerate the degenerative process. While DDD is often a natural part of aging, the accelerated progression observed in this Veteran is likely attributable to the physical demands of [his/her] military service.
Sincerely,
[Medical Professional’s Name] -
Sample 20: Erectile Dysfunction (ED) Nexus Letter
[Date]
To Whom It May Concern:This letter concerns my patient, Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], who is seeking service connection for erectile dysfunction (ED).
Based on my review of [his/her] medical records, service records, and a thorough physical examination, it is my professional medical opinion, to a reasonable degree of medical certainty, that Veteran [Veteran’s Name]‘s ED is secondary to [his/her] service-connected condition of [Name of Service-Connected Condition, e.g., PTSD, Diabetes, medication prescribed for service-connected condition].
[Explain the connection clearly and specifically. For example: “The Veteran’s PTSD is well-documented and treated with [medication name], a medication known to have ED as a potential side effect. While other factors may contribute, the medication is a significant factor in the development of his ED.” OR “The Veteran’s service-connected diabetes has led to vascular damage that is impairing blood flow to the penis, resulting in ED.”]
Sincerely,
[Medical Professional’s Name] -
Sample 21: Cold Weather Injury (e.g., Frostbite) Nexus Letter
[Date]
To Whom It May Concern:I am writing on behalf of Veteran [Veteran’s Name], VA Claim Number [VA Claim Number], regarding [his/her] claim for long-term effects resulting from a cold weather injury sustained during military service.
After reviewing [his/her] medical and service records, it is my professional medical opinion that Veteran [Veteran’s Name]‘s current condition of [Specify the current condition resulting from the cold weather injury, e.g., chronic pain, nerve damage, increased sensitivity to cold] is directly related to the frostbite injury sustained on [Date] while serving in [Location/Unit] during [Operation/Exercise].
According to the Veteran’s service records, [He/She] was exposed to extreme cold temperatures for a prolonged period without adequate protection, resulting in frostbite to [affected body part]. The current symptoms are consistent with the long-term sequelae of frostbite, including [describe the specific symptoms and how they relate to the initial injury].
Sincerely,
[Medical Professional’s Name]
Key Takeaways and Disclaimer
These nexus letter samples are intended as illustrative examples only. It is critical to consult with your own qualified medical professional to obtain a personalized and accurate nexus letter based on your specific circumstances. A strong nexus letter tailored to your individual case will significantly improve your chances of a successful VA disability claim. These samples highlight the importance of clearly establishing a link between your current medical condition and your military service. Remember to provide your medical professional with all relevant medical and service records.
