What is a Nexus Report?

Also Known as a Disability Nexus Medical Report

A VA Disability Nexus Letter is a medical expert’s written opinion explaining the connection—or “nexus”—between a veteran’s military service and a current physical or psychological condition.
For many veterans seeking VA disability compensation, a well-supported Nexus Letter can be an important piece of medical evidence.
What Does a Nexus Letter Do?
A qualified physician reviews the veteran’s medical history and available evidence, which may include:
Military service and treatment records VA and civilian medical records Diagnostic tests and imaging The veteran’s history of injuries, symptoms, and exposures Relevant medical and scientific literature The nature and progression of the veteran’s current condition
The physician then provides a medical opinion addressing whether the veteran’s current condition is related to military service—or, when appropriate, whether it was caused or aggravated by another service-connected condition.
The goal is to connect the medical dots between what happened during or because of military service and the disability the veteran has today.
START With Your Doctor’s Nexus Letter
A senior federal employee involved in training VA raters once advised Doc Ellis that veterans should not assume that beginning with a VA medical evaluation is always the best approach.
His recommendation was simple:
Start by developing the medical evidence. He believed veterans could benefit from first obtaining a thorough medical evaluation and Nexus Letter from a physician experienced in VA disability medicine—someone who understands both the medical evidence and the questions that must be addressed in a VA disability claim. He believed in this approach strongly enough that he traveled from Ohio to Oklahoma to obtain his own Nexus Letter. Why Start With a Qualified Doctor? 1. Medical evidence matters. A disability claim should be supported by medical evidence that clearly explains the veteran’s diagnosis, history, and the medical relationship between the condition and military service. 2. Military medical records may not tell the entire story. Service treatment records may document only part of an injury, illness, exposure, or symptoms experienced during military service. 3. Some veterans have few or no useful military medical records. A lack of extensive service treatment records does not necessarily mean that a medically supportable relationship to military service cannot be established. 4. A Nexus Letter provides medical reasoning—not just a conclusion. A strong Nexus Letter explains why the physician believes the veteran’s condition is related to military service and identifies the evidence supporting that opinion. What Should a Good Nexus Letter Include? A strong Nexus Letter should clearly identify the veteran’s current medical condition and explain its relationship to military service. It should include a reasoned medical explanation supported by the veteran’s history, medical records, examination findings, diagnostic evidence, and relevant medical literature when appropriate. The physician should do more than simply state an opinion. The physician should explain how and why the medical evidence supports that opinion. Few or Missing Military Medical Records? That Does Not Necessarily End the Claim. Veterans sometimes believe they cannot establish service connection because an injury, illness, exposure, or symptom was never adequately documented during military service. That is not necessarily the case. Tell your physician about your military duties, injuries, illnesses, symptoms, environmental exposures, repetitive activities, physical demands, and other medically relevant experiences. A qualified physician can consider the veteran’s reported history together with the available medical evidence and determine whether there is a medically supportable basis for a Nexus opinion. The resulting Nexus Letter then becomes medical evidence supporting the claim. Remember: Legal Medicine Is Not Typically Taught in Medical School Being an excellent physician does not automatically mean a doctor has experience preparing medical opinions for VA disability claims. VA disability cases involve both medicine and specific legal evidentiary standards. Your physician should understand how to: Review and interpret the relevant medical evidence Address direct and secondary service connection Address aggravation when applicable Consider competing causes and risk factors Explain medical causation clearly Provide a well-reasoned medical rationale Use the appropriate VA evidentiary language when warranted Choose Your Nexus Physician Carefully Look for a physician who has substantial experience evaluating veterans and preparing VA Disability Nexus Letters. And compare fees carefully. Some providers charge extremely high prices for Nexus Letters. A high fee does not necessarily mean that the medical opinion will be better, more persuasive, or more useful to the VA. The quality of a Nexus Letter depends on the medical evidence, the physician’s expertise, and the strength of the medical reasoning—not the price of the report. A Strong Nexus Letter Connects the Evidence A Nexus Letter should not simply say that a veteran’s condition is service connected. It should explain: What happened during military service → what condition exists today → and medically, how the two are connected. That medical explanation can be one of the most important pieces of evidence in a VA disability claim. God Bless Doc Ellis, John W. Ellis, M.D., Captain, US Army Flight Surgeon, Retired