Nexus Letter and how to make it work for you.

A claim for a Veterans Benefits Administration (VBA) disability compensation award

must be based on irrefutable evidence. If the claim leaves any doubt in the mind of

the ratings specialist who makes that award decision, you may be denied.

This is often the case when the veteran alleged that an injury or illness that

occurred in service has worsened over the years. While the condition may have been

relatively minor then, it's significantly disabling today.

To show that there exists a connection between his/her documented service event

(exposure to CBR elements, wounding, illness) and a condition today (cancer,

worsening of original injury, etc.) requires that the veteran present a favorable

opinion of an expert who agrees with his/her thought process. This is known as a

nexus letter. A simple definition of nexus is: Tie; bond; link; connection or

interconnection.

When writing a nexus letter, a few points to remember are in order.

· The letter should be as brief as possible while stating facts

· The author must be an expert.

· This is most often a medical doctor who is board certified in the area of

health that's at issue.

· If cancer is the condition, an oncologist is preferred.

· If an old injury to a bone is in question, an orthopedic surgeon is the obvious

choice.

· PTSD has become more controversial in recent years and it's

accepted today that a clinical psychiatrist or psychologist is the

gold standard for opinions related to the condition.

· The expert who signs the nexus letter must have thoroughly

reviewed all available and pertinent medical records (to include

Service Medical Records) and state that fact in the letter. If the

expert can't reasonably verify that all records were reviewed, the

letter won't be of much value.

· The nexus letter should be as detailed and complete as the

circumstances dictate.

Although it may not always be an absolute requirement, it will lend a lot of weight if the

writer of the nexus letter has recently examined the veteran.

The doctor who writes the letter does not have to use absolutes or conclusions in his or

her statements. Opinions are made based on conjecture of observing facts and

possibilities arising from those facts.

This means that the author isn't required to say that one thing definitely caused

another only that it might have or is likely to have led from point A to point B.

The preferred language to describe an expert's opinion should express whether "it is

more likely than not (i.e., probability greater than 50 percent), at least as likely as not

(i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50

percent) that (the condition) was incurred or aggravated during active service.

In practical terms, the nexus letter is a powerful tool for the veteran to use to establish

a claim. Often the VA will recognize that the physician who writes your nexus letter is

better trained, better experienced or spent more time examining you than a VA

Compensation and Pension (C&P) examiner did. In many cases at the VARO level as

well as the Veterans Board of Appeals and in higher courts, the expert opinion

expressed in a nexus letter has been the deciding factor that wins a Veteran those well

deserved benefits.

Many physicians, both civilian and VA doctors, are reluctant to write such a letter.

Sometimes, they are concerned that there are legal pitfalls that can arise from writing

disability letters and they want to avoid such. While there probably are some legal

issues to consider, I'm not aware of any physician ever suffering any repercussions from

writing a truthful, factual nexus letter.

In my experience, the physician is most often simply too busy to write such letters or

isn't sure of the proper statements to make. Keeping it simple is your best chance for

the doctor signing the letter. It is also best to have your doctor write the letter on his

letterhead.

If the veteran’s personal doctor won't write such a letter, the veteran will have to seek

out a physician who specializes in Independent Medical Examinations or IME's. The

doctor who is a specialist in Independent Medical Examination is usually thought to be

above reproach as their living depends on their reputation as an impartial reporter of

facts. They will often know the language that's needed very well and they spend a lot of

time examining the patient and reviewing the records.

The IME doctor may be expensive and the veteran must pay the bill up front and out of

his/her own pocket. These IME opinions may cost from $600.00 to $1500.00 or more.

There is no guarantee that the IME doctor will agree with the veteran’s thinking and if the

report is not in agreement with the veteran, he/she will not get their money back.

Example of nexus letter;

DATE

Reference: VETERAN’S NAME

ADDRESS ETC.

To Whom It May Concern;

I am Dr. Quack. I am board certified to practice in my specialty. A CV is included.

Mr. John Doe is a patient under my care since DATE. His diagnosis is YOUR

CONDITION, etc.

I have personally reviewed his medical history (NAME DOCUMENTS) and I've also

reviewed his history of the (EVENT OR EVENTS YOU CLAIM ARE THE CAUSE OF

YOUR CONDITION) while he served during his military service.

I am familiar with his history and have examined Mr. Doe often while he has been

under my care. (SPECIFY LAB WORK, X-RAYS, ETC.)

Mr. John Doe has no other known risk factors that may have precipitated his current

condition.

In my personal experience and in the medical literature it is known, ETC.

It is my opinion that it is more likely than not that Mr. John Doe's condition ETC.

SIGNED

Dr. Quack, M.D.