A Nexus Letter, also known as a Medical Nexus Letter or Independent Medical Opinion (IMO), is a crucial piece of evidence in VA disability claims. It establishes the link, or “nexus,” between your current medical condition and your military service. A well-written nexus letter, prepared by a qualified medical professional, strengthens your claim considerably, demonstrating that your disability is “more likely than not” related to your service. Without a strong nexus, the VA may deny your claim even if you have documented service records and current diagnoses.
These sample nexus letters, presented as a nexus letter sample PDF, offer various examples of effective language and content. They demonstrate how medical professionals can articulate the connection between a veteran’s service and their current health challenges. Reviewing these examples will provide a better understanding of the structure, key elements, and persuasive techniques used in a successful nexus letter. Remember to tailor the letter to your specific situation and have it written by a medical professional familiar with your case and the VA claims process.
Before diving into the samples, understand the key components: a clear statement of the doctor’s qualifications, a review of your medical and service records, a clear opinion linking your condition to your service (the “nexus”), and a reasoned explanation supporting that opinion. The strength of the explanation often determines the persuasiveness of the letter. These samples will help you and your doctor understand how to structure that explanation effectively. Note that downloading the nexus letter sample PDF is often beneficial for easy reference during the drafting process. Remember, these are templates and your doctor should adjust them to reflect your unique medical history and service record.
The following nexus letter sample PDF examples are designed to showcase a range of situations and conditions. Each example illustrates different approaches to establishing the nexus and provides valuable insights into the language and tone that are most effective in persuading the VA. By carefully reviewing these samples, you can gain a clearer understanding of how to work with your doctor to develop a compelling and supportive nexus letter. Ensure your doctor has all relevant records and a thorough understanding of your military service and medical history.
9 Nexus Letter Samples
Sample 1: General Connection
[Doctor’s Name, Credentials]
[Doctor’s Address]
[Date]
Department of Veterans Affairs
[VA Address]
RE: Nexus Letter for [Veteran’s Name], [Veteran’s Claim Number]
To Whom It May Concern:
I am writing this letter on behalf of my patient, [Veteran’s Name], to provide my professional medical opinion regarding the relationship between their current medical condition of [Diagnosis] and their military service.
I have reviewed [Veteran’s Name]’s medical records, including [List specific records reviewed, e.g., VA medical records, service treatment records]. I have also personally examined [Veteran’s Name] on [Date(s) of Examination(s)].
Based on my review of these records and my clinical examination, it is my professional medical opinion that it is “more likely than not” that [Veteran’s Name]’s current diagnosis of [Diagnosis] is directly related to their military service, specifically [Describe the event or exposure during service that contributed to the condition].
My reasoning for this opinion is based on the following:
- [Explain the medical rationale linking the service event to the current condition. Be specific and use medical terminology.]
- [Provide additional supporting evidence from medical literature or research.]
Therefore, it is my considered medical opinion that a nexus exists between [Veteran’s Name]’s military service and their current medical condition.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name, Credentials]
Sample 2: Pre-existing Condition Aggravation
[Doctor’s Name, Credentials]
[Doctor’s Address]
[Date]
Department of Veterans Affairs
[VA Address]
RE: Nexus Letter for [Veteran’s Name], [Veteran’s Claim Number] – Aggravation of Pre-existing [Condition]
To Whom It May Concern:
I am writing regarding my patient, [Veteran’s Name], and their claim for service connection for aggravation of a pre-existing condition of [Condition].
I have reviewed [Veteran’s Name]’s medical history, including documentation indicating the pre-existing nature of their [Condition]. I have also examined them on [Date(s)]. My review includes [List records reviewed].
In my professional medical opinion, it is at least “more likely than not” that [Veteran’s Name]’s military service significantly aggravated their pre-existing [Condition] beyond its natural progression.
My opinion is based on the following:
- [Describe the veteran’s condition upon entering service, citing relevant records].
- [Explain how specific aspects of their military service, such as [specific tasks or deployments], demonstrably worsened the condition].
- [Explain the current severity of the condition and why it exceeds the natural progression given the initial state of the condition].
- [Cite any medical literature or studies supporting the link between the service events and the aggravation of the condition].
Therefore, it is my opinion that [Veteran’s Name]’s military service was a significant factor in the current severity of their [Condition].
Sincerely,
[Doctor’s Signature]
[Doctor’s Name, Credentials]
Sample 3: Secondary Condition
[Doctor’s Name, Credentials]
[Doctor’s Address]
[Date]
Department of Veterans Affairs
[VA Address]
RE: Nexus Letter for [Veteran’s Name], [Veteran’s Claim Number] – Secondary to Service-Connected [Primary Condition]
To Whom It May Concern:
This letter concerns my patient, [Veteran’s Name], and their claim for a secondary service connection for [Secondary Condition] resulting from their service-connected [Primary Condition].
I have reviewed [Veteran’s Name]’s medical records, focusing on the progression of both [Primary Condition] and [Secondary Condition]. My review includes [List records reviewed]. I have also examined them on [Date(s)].
Based on my review and examination, it is my professional medical opinion that it is “more likely than not” that [Veteran’s Name]’s [Secondary Condition] is directly caused or significantly aggravated by their service-connected [Primary Condition].
My rationale is based on the following:
- [Explain the established medical link between [Primary Condition] and [Secondary Condition], citing medical literature].
- [Describe the progression of [Primary Condition] in [Veteran’s Name]’s case and how it led to the development or worsening of [Secondary Condition]].
- [Specifically address how treatment or management of [Primary Condition] has impacted [Secondary Condition]].
- [Rule out other potential causes of [Secondary Condition] to strengthen the connection to the service-connected condition].
Therefore, in my professional opinion, [Veteran’s Name]’s [Secondary Condition] is directly related to their service-connected [Primary Condition].
Sincerely,
[Doctor’s Signature]
[Doctor’s Name, Credentials]
Sample 4: Gulf War Syndrome
[Doctor’s Name, Credentials]
[Doctor’s Address]
[Date]
Department of Veterans Affairs
[VA Address]
RE: Nexus Letter for [Veteran’s Name], [Veteran’s Claim Number] – Gulf War Syndrome
To Whom It May Concern:
I am writing to support the claim of my patient, [Veteran’s Name], for disability benefits related to Gulf War Syndrome (also known as Chronic Multisymptom Illness). [Veteran’s Name] served in the Persian Gulf War from [Start Date] to [End Date].
I have reviewed [Veteran’s Name]’s medical records, service records, and personal history. This includes [List specific records reviewed]. I have also personally examined [Veteran’s Name] on [Date(s) of Examination(s)].
Based on my review and examination, it is my professional medical opinion that it is “more likely than not” that [Veteran’s Name]’s current medical conditions, specifically [List specific symptoms and diagnoses, e.g., chronic fatigue, fibromyalgia, irritable bowel syndrome], are related to their service in the Persian Gulf War.
My reasoning is based on the following:
- [Veteran’s Name] presents with a cluster of symptoms consistent with Gulf War Syndrome, as defined by the VA and medical literature.
- The onset of these symptoms occurred during or shortly after their deployment to the Persian Gulf.
- [Explain potential exposures during service, e.g., to chemical weapons, pesticides, or infectious diseases].
- [Rule out other potential causes of the symptoms, if possible].
- [Cite relevant medical literature and VA regulations regarding Gulf War Syndrome].
Therefore, it is my medical opinion that a nexus exists between [Veteran’s Name]’s service in the Persian Gulf War and their current health problems.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name, Credentials]
Sample 5: PTSD Nexus Letter
[Doctor’s Name, Credentials]
[Doctor’s Address]
[Date]
Department of Veterans Affairs
[VA Address]
RE: Nexus Letter for [Veteran’s Name], [Veteran’s Claim Number] – Post-Traumatic Stress Disorder (PTSD)
To Whom It May Concern:
I am writing to provide my professional medical opinion regarding the claim of my patient, [Veteran’s Name], for service connection for Post-Traumatic Stress Disorder (PTSD).
I have reviewed [Veteran’s Name]’s medical records, including therapy notes and psychological evaluations. I have also reviewed their service records, specifically [Mention any relevant documents detailing the stressor]. I have also personally examined [Veteran’s Name] on [Date(s) of Examination(s)].
Based on my review and examination, it is my professional medical opinion that it is “more likely than not” that [Veteran’s Name]’s diagnosis of PTSD is directly related to a traumatic event that occurred during their military service, specifically [Describe the traumatic event in detail, if permissible by HIPAA and with the veteran’s consent. Be specific about the veteran’s role and experience during the event].
My reasoning is based on the following:
- [Veteran’s Name] meets the diagnostic criteria for PTSD according to the DSM-5 [or current diagnostic manual].
- The symptoms of PTSD, including [List specific symptoms the veteran experiences], began shortly after the traumatic event and have persisted since.
- [The traumatic event is consistent with the types of stressors that are known to cause PTSD].
- [Explain the psychological mechanisms by which the traumatic event led to the development of PTSD in this particular individual. Refer to established psychological theories].
Therefore, it is my medical opinion that a clear nexus exists between [Veteran’s Name]’s military service and their current diagnosis of PTSD.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name, Credentials]
Sample 6: Burn Pit Exposure
[Doctor’s Name, Credentials]
[Doctor’s Address]
[Date]
Department of Veterans Affairs
[VA Address]
RE: Nexus Letter for [Veteran’s Name], [Veteran’s Claim Number] – Burn Pit Exposure
To Whom It May Concern:
This letter concerns my patient, [Veteran’s Name], and their claim for disability related to exposure to burn pits during their military service.
I have reviewed [Veteran’s Name]’s medical and service records, including documentation of their deployment to [Location with burn pits] from [Start Date] to [End Date]. This review included [list documents reviewed]. I have also examined them on [Date(s) of examination].
In my professional medical opinion, it is at least “more likely than not” that [Veteran’s Name]’s current diagnosis of [Specific condition, e.g., constrictive bronchiolitis, asthma, certain cancers] is related to their exposure to burn pits during their service.
My opinion is based on the following:
- [Documented exposure to burn pits at [Location] during their deployment. Provide specifics if available].
- [The temporal relationship between the exposure and the onset of symptoms, noting when symptoms began or worsened].
- [Explain the known toxic components of burn pit smoke and their potential to cause respiratory and other health issues, citing relevant scientific studies and research].
- [Address any other potential causes for the condition and why burn pit exposure is the most likely factor].
- [If applicable, mention any VA presumptive conditions related to burn pit exposure].
Therefore, it is my professional medical opinion that a nexus exists between [Veteran’s Name]’s exposure to burn pits and their current medical condition.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name, Credentials]
Sample 7: Hearing Loss/Tinnitus
[Doctor’s Name, Credentials]
[Doctor’s Address]
[Date]
Department of Veterans Affairs
[VA Address]
RE: Nexus Letter for [Veteran’s Name], [Veteran’s Claim Number] – Hearing Loss and/or Tinnitus
To Whom It May Concern:
I am writing on behalf of my patient, [Veteran’s Name], to provide my professional medical opinion regarding the relationship between their current hearing loss and/or tinnitus, and their military service.
I have reviewed [Veteran’s Name]’s medical records, including audiograms, and their service records, specifically focusing on their military occupational specialty (MOS) and potential noise exposures. My review includes [List specific records reviewed]. I have also examined [Veteran’s Name] on [Date(s) of Examination(s)].
Based on my review of these records and my clinical examination, it is my professional medical opinion that it is “more likely than not” that [Veteran’s Name]’s current hearing loss and/or tinnitus is directly related to noise exposure during their military service, specifically [Describe the specific noise exposures, e.g., firing weapons, working in engine rooms, aircraft maintenance].
My reasoning for this opinion is based on the following:
- [Veteran’s Name]’s audiogram demonstrates a pattern of hearing loss consistent with noise-induced hearing loss, often showing a “notch” at 4000 Hz].
- [Their MOS ([Military Occupational Specialty]) involved significant and prolonged exposure to loud noises without adequate hearing protection].
- [Explain the known mechanisms by which noise exposure damages the inner ear and causes hearing loss and/or tinnitus].
- [Address the absence of any other significant risk factors for hearing loss, such as genetic predisposition or ototoxic medications, to strengthen the connection to service].
Therefore, it is my considered medical opinion that a nexus exists between [Veteran’s Name]’s military service and their current hearing loss and/or tinnitus.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name, Credentials]
Sample 8: Musculoskeletal Condition
[Doctor’s Name, Credentials]
[Doctor’s Address]
[Date]
Department of Veterans Affairs
[VA Address]
RE: Nexus Letter for [Veteran’s Name], [Veteran’s Claim Number] – Musculoskeletal Condition – [Specific Condition, e.g., Back Pain, Knee Injury]
To Whom It May Concern:
I am writing to provide my professional medical opinion regarding my patient, [Veteran’s Name], and their claim for disability related to a musculoskeletal condition, specifically [Specific Condition, e.g., Back Pain, Knee Injury].
I have reviewed [Veteran’s Name]’s medical and service records. This includes [List specific records reviewed, such as physical therapy notes, imaging reports, and service records describing physical demands of their job]. I have also personally examined [Veteran’s Name] on [Date(s) of Examination(s)].
Based on my review and examination, it is my professional medical opinion that it is “more likely than not” that [Veteran’s Name]’s current diagnosis of [Specific Condition] is directly related to the physical demands of their military service, particularly [Describe the specific activities or events during service that contributed to the condition, e.g., heavy lifting, prolonged standing, parachute jumps].
My reasoning is based on the following:
- [Describe the specific physical demands of [Veteran’s Name]’s military duties, citing specific examples and, if possible, documentation].
- [Explain the biomechanical mechanisms by which those activities could have caused or aggravated the [Specific Condition]].
- [Document the onset of symptoms during or shortly after the period of physically demanding service].
- [Address any pre-existing conditions or other potential contributing factors, and explain why the service-related activities are the primary cause or significantly aggravated the condition].
- [Cite relevant medical literature supporting the link between the described activities and the [Specific Condition]].
Therefore, it is my medical opinion that a nexus exists between [Veteran’s Name]’s military service and their current musculoskeletal condition.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name, Credentials]
Sample 9: Cold Weather Injuries (e.g., Frostbite)
[Doctor’s Name, Credentials]
[Doctor’s Address]
[Date]
Department of Veterans Affairs
[VA Address]
RE: Nexus Letter for [Veteran’s Name], [Veteran’s Claim Number] – Cold Weather Injuries (Frostbite)
To Whom It May Concern:
I am writing to support the claim of my patient, [Veteran’s Name], for disability benefits related to cold weather injuries, specifically frostbite, sustained during their military service.
I have reviewed [Veteran’s Name]’s medical records, service records, and personal history. This includes [List specific records reviewed, e.g., service treatment records documenting the frostbite injury, deployment orders to cold weather regions]. I have also personally examined [Veteran’s Name] on [Date(s) of Examination(s)].
Based on my review and examination, it is my professional medical opinion that it is “more likely than not” that [Veteran’s Name]’s current medical conditions, specifically [List specific symptoms and diagnoses, e.g., chronic pain, nerve damage, sensitivity to cold], are directly related to the frostbite injury sustained during their military service, specifically [Describe the circumstances of the cold weather exposure, e.g., location, duration, lack of adequate protective gear].
My reasoning is based on the following:
- [Documented history of frostbite injury during military service, with specific details of the event].
- [The temporal relationship between the frostbite injury and the onset of the current symptoms].
- [Explain the known long-term sequelae of frostbite injuries, including nerve damage, chronic pain, and increased sensitivity to cold].
- [Address any other potential causes of the symptoms, and explain why the frostbite injury is the most likely factor].
Therefore, it is my medical opinion that a nexus exists between [Veteran’s Name]’s military service and their current health problems related to frostbite.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name, Credentials]
Conclusion
These nexus letter sample PDF examples provide a strong foundation for understanding how to obtain supportive documentation for VA disability claims. Remember that a nexus letter is a critical piece of evidence, and working closely with your doctor to personalize it to your specific medical history and service record is essential for a successful outcome. Always ensure the letter is accurate, thorough, and clearly articulates the connection between your military service and your current disabilities.
