Nexus Letters: What the VA Looks For and How to Get One

March 12, 2026

By J. Erickson

nexus letter, medical opinion, evidence, IME

"A nexus letter can make or break your VA claim. Learn what it must include, who can write it, and how to get one that the VA will accept."

━━━THE VETERAN'S TAKE━━━

What Is a Nexus Letter?

A nexus letter is a medical opinion that establishes a connection between your current condition and your military service. It's one of the three things the VA requires for service connection.

Why Nexus Letters Matter

The VA C&P examiner provides a medical opinion as part of your exam, but that opinion isn't always favorable. A strong nexus letter from your own provider can counter an unfavorable C&P opinion.

What Makes a Strong Nexus Letter

1. The Right Language

The magic phrase: "At least as likely as not (50% or greater probability)"

2. Credentials of the Provider

MDs, DOs, PAs, NPs, and PhDs in relevant fields can write nexus letters.

3. Review of Evidence

The provider should state what evidence they reviewed.

4. Medical Rationale

The letter must explain WHY the condition is connected to service.

5. Specific Opinion

The letter should clearly state the opinion linking the condition to service.

Who Can Write a Nexus Letter?

Medical Doctors, Doctors of Osteopathy, Nurse Practitioners, Physician Assistants, and Psychologists (for mental health conditions).

How to Get a Nexus Letter

Your treating provider
Private medical opinion
Independent Medical Examination (IME)

Common Nexus Letter Mistakes

Weak language
No rationale
Generic/templated
No review of records
Wrong provider type

The Bottom Line

A nexus letter is often the most important piece of evidence in a VA claim. Get one that uses the right language, comes from a qualified provider, reviews your records, and explains WHY your condition is connected to service.

U.S. Air Force service dress uniform with Staff Sergeant rank insignia

About FWD Assist HQ

J. Erickson is a service-disabled Air Force veteran. He served as a military firefighter and as a veteran service officer, where he spent years walking veterans through the same claims process he writes about now. He holds an MBA and writes plain-language guides for veterans who want to understand the system without a translator. Learn more about the mission.

Educational Content Only: This article is for educational purposes only and does not constitute legal or professional claims advice. If you need help with your VA claim, start by contacting your local Veterans Service Organization (VSO) -- they're free, accredited, and can represent you through the entire process. If your situation requires more specialized support, consider consulting an accredited VA attorney or claims agent.

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