The NEXUS Letter

The NEXUS Letter

The NEXUS Letter / Veterans Affairs


A Veterans Affairs claim exam is different from a regular medical appointment because the examiner won’t prescribe any medicine or treat the veteran – for instance, they won’t receive a referral to a specialist. The examiner will only address the claimed disabilities that VA determined warrant an examination. Following the veteran's exam, the exam results will be uploaded to their VA claims file (also known as a C - File). These results will be used along with the evidence of record to make a decision on the veteran's claim.To win an award of a disability benefit, the veteran must meet 3 criteria:

  • Show eligibility of their military service.
  • Have a current medical diagnosis of a condition or a disability.
  • Be able to provide evidence that the medical diagnosed condition had its origin during the time of their military service, or if the condition was preexisting, that it was aggravated by their military service.

According to Vet.Law, "Securing the VA disability benefits you deserve is not always easy. Even if you are confident that your health condition is the result of your service in the military, you may not be approved for benefits unless there is compelling evidence to support the link between the two. A medical nexus letter is one of the best means of showing this connection.


A nexus letter explains the extent to which a veteran’s medical condition is connected to their military service. It is written by a qualified health care provider and is reviewed in conjunction with other medical documentation to determine the benefits for which you are eligible."


The Importance Of A Strong Medical Nexus Letter / Vet.Law

The importance of the nexus letter can't be overstated. In many situations the nexus letter from an expert is the only evidence that will tip the scales in favor of the veteran.

Writing the NEXUS Letter:


It is perfectly acceptable for the veteran to write the letter on behalf of the physician and then ask the physician to sign it. In any setting, whether VA or civilian, the veteran is advised that he or she should not ask a nurse or clerk to perform the task of obtaining a signature for them. These ancillary members of the care team often see themselves as "gatekeepers" to guard and protect the physician from tasks that will only take up more valuable time.


They may believe that "rules" or "law" won't allow the physician to sign such a document and the veteran may be refused access to the doctor. It's best to make a routine appointment, wait until the veteran is face to face with the M.D. and ask that provider directly.

Most physicians will sign such a letter if it is brief, to the point and factual. When writing a nexus letter great care must be given to recording only facts and the doctor's conclusions.


There are physicians available who will perform records reviews and/or Independent Medical Examinations and provide opinions. Often these doctors do a very good job of providing a nexus letter if the veteran isn't otherwise able to obtain one. The charge for such a letter from an independent physician can vary depending on the extent of the services. The veteran must pay that fee in advance with no guarantee that any award will be won. The Independent Medical Examining doctor does not treat or prescribe medications but only provides services of review and report.

  • Veterans Affairs Forms & Information

    VA Disability Compensation

    VA disability compensation (pay) offers a monthly tax-free payment to Veterans who got sick or injured while serving in the military and to Veterans whose service made an existing condition worse. 


    How to File a VA Disability Claim

    Find out how to file a claim for disability compensation or increased disability compensation.


    VA Form 21-526EZ (Application for Disability Compensation and Related Compensation Benefits).


    Signing in to VA.gov

    Get answers to your questions about signing in to VA.gov to manage your benefits and services online. 


    Direct Deposit for your VA benefit payments

    Learn about getting your VA benefit payments through direct deposit. If you don’t already have a bank account, the Veterans Benefits Banking Program (VBBP) can connect you with a bank that will work with you to set up an account. If you already have one, find out how to change your direct deposit information.


    Managing your VA.gov profile

    Your VA.gov profile has your contact, personal, and military information. Keep reading to find out how to keep your profile up to date.



  • Veteran Service Officers

    If you need help filing a claim or appeal, you may want to work with an accredited attorney, a claims agent, or a Veterans Service Officer (VSO). We trust these professionals because they’re trained and certified in the VA claims and appeals processes. They can help you with VA-related needs.


    VSOs work on behalf of Veterans and service members—as well as their dependents and survivors. Find out more about accredited representatives and how they can help you.Accredited representatives and VSOs need to meet these requirements:

    • Pass an exam
    • Pass a background check
    • Take continuing-education courses to make sure they’re providing the most up-to-date information

    What does an accredited representative or a VSO do?

    Accredited representatives and VSOs can help you understand and apply for VA benefits, like these:

    • Financial support (monthly payments)
    • Education
    • Veteran Readiness and Employment (VR&E)
    • Home loans
    • Life insurance
    • Pension
    • Health care
    • Burial benefits

    These trained professionals can also help in these ways:

    • Help you gather supporting documents (like a doctor’s report or medical test results)
    • File a claim or appeal on your behalf
    • Provide added support, like helping with transportation to medical appointments or emergency funds

    Note: If your claim has a clear factual or legal error, your accredited representative or VSO can request a faster Higher-Level Review decision through a new pilot program called Claim Accuracy Request (CAR).

    Veteran Service Organizations:


    Recognized organizations and individuals can legally represent a Veteran, service member, dependent, or survivor before VA. 

    Non-recognized organizations and individuals can provide information, but can’t be representatives.

    Note: Veterans Service Officers work for Veterans Service Organizations (both are called VSOs), as well as for local government offices.


    Veteran Service Officers (NYC)

    VA Regional Office (Manhattan)

    245 W. Houston


    American Legion

    (212)807-3066

    Mon-Fri: 9am-2pm


    Disabled American Veteran (DAV)

    (212)807-3157

    Mon, Tues, Thurs, & Fri: 8:30am-3pm

    Wed: 8:30am-12pm


    Paralyzed Veterans of America

    (212)807-3114

    Mon-Fri: 8am-4:30pm


    United War Veterans

    (212)693-1476

    Mon-Fri: 7am-4pm


    New York State Division of Veterans Affairs

    (212)807-3162

    Mon-Fri: 8am-4pm

  • NEXUS Letter / Back Injury

    For the purposes of this example, let's consider a back injury.


    You may have hurt your back in some fashion while serving your country. That was in 1970 and you went on sick call. Your sore back was diagnosed as a "pulled muscle" or something similar and you were given some IBU Profen and sent on your way to light duty for 3 days.


    The back was progressively more painful so you were back on sick call a week later. This time an x-ray was ordered and you were given some stronger pain pills and your light duty was increased to a restricted duty for a month with orders of no lifting, no PT and so on.


    The military culture demands that we don't complain of our "minor" aches and pains. The team depends on each member being ready to complete the mission and the mission is all that counts. From day one we're trained that  complaints of pain will bring about scorn from superiors and fellow soldiers will know that they have to carry your load as well as their own. "Pain", we learn, "is weakness leaving your body." 


    Your civilian career wasn't as physical as the military and during the years since your discharge you've had chronic, low back pain but it hasn't required much treatment...until now. In the last year you've had to seek more intensive medical care and finally you had an MRI. The MRI study shows numerous issues with discs and nerves and you realize that your old service injury is here to haunt you. You file for service connected disability compensation, you have a C & P exam and about a year later you have a denial letter. The VA tells you that although you had complaints during your service that your condition today is new and unrelated to those old problems.


    Now what?

  • NEXUS Letter Example / Back Injury

    EXAMPLE OF NEXUS LETTER


    Doctor's Letter Head


    Date:


    Subject: Medical history of Mr. Veteran


    Reference: C-File # and/or Social Security Number


    To the Department of Veterans Affairs:


    I am the primary care provider for Mr. Veteran. In my capacity as a primary care provider, I have cared for Mr. Veteran since 01/07/20xx.


    While I've provided care for Mr. Veteran, I've become familiar with his active duty medical history from 07/24/19xx to 08/07/19xx and from VA medical records from 19xx to present, past and present ailments and I've reviewed pertinent parts of his military record that document his injury, disease and clinical conditions related to the events that occurred.


    I am aware that Mr. Veteran was injured during his active duty military service on or about 1981 in Fort Army while (events description, time and place).


    A primary condition the veteran suffers is Lumbar Paravertebral Myositis (an Inflammatory Myopathy) and an L4-L5, disc desiccation and disc narrowing. MRI reports note sacralization of the L 5 representing a developmental abnormality and also that paraspinal muscle spasm is suggested.


    Further noted are mild thoracolumbar dextroscoliosis as well as mild spondylosis and degenerative endplate changes. Schmorl's nodes in the superior endplate of L3. L3-L4 and L4-5 degenerative disc disease are seen. There is an L4-5 small posterior disc bulge and small posterocentral disc herniation and L2-3 vertebral hemangiomas.


    Mr. Veteran has chronic pain due to his injuries. The veteran suffers radiculopathy with pain, muscle control difficulty, tingling, numbness and weakness in the legs, likely due the sacralization of L4-L5.


    Mr. Veteran suffers increased fatigability because of his chronic back pain. Standing for more than 15 minutes will make him become weak and exhausted.


    There are multiple other clinical conditions diagnosed that are more likely than not secondary to or aggravated by the primary back condition(s).


    The veteran takes numerous medications for both the primary condition as well as secondary conditions that are aggravated by said primary back condition. (Medicines and secondary conditions are listed separately.)


    The veteran is not a likely candidate to be rehabilitated.


    After examining Mr. Veteran, his chart and medical records it is my opinion that Mr. Veteran is totally and permanently disabled due to the above discussed back condition. The veteran can not hold gainful employment as a result of the injury he sustained while in the military. It is also my opinion that it is more likely than not the that the physical traumas suffered during the veteran's military service as noted in his record (description of events and dates) caused, contributed to and aggravated the totally disabling back condition(s).


    Respectfully,


    Dr. VA Physician, MD


    Diplomat of the American Board of Internal Medicine

EXAMPLE OF NEXUS LETTER


Doctor's Letter Head

Date:

Subject: Medical history of Mr. Veteran

Reference: C-File # and/or Social Security Number


To the Department of Veterans Affairs:


I am the primary care provider for Mr. Veteran. In my capacity as a primary care provider, I have cared for Mr. Veteran since 01/07/20xx.


While I've provided care for Mr. Veteran, I've become familiar with his active duty medical history from 07/24/19xx to 08/07/19xx and from VA medical records from 19xx to present, past and present ailments and I've reviewed pertinent parts of his military record that document his injury, disease and clinical conditions related to the events that occurred.


I am aware that Mr. Veteran was injured during his active duty military service on or about 1981 in Fort Army while (events description, time and place).


A primary condition the veteran suffers is Lumbar Paravertebral Myositis (an Inflammatory Myopathy) and an L4-L5, disc desiccation and disc narrowing. MRI reports note sacralization of the L 5 representing a developmental abnormality and also that paraspinal muscle spasm is suggested.


Further noted are mild thoracolumbar dextroscoliosis as well as mild spondylosis and degenerative endplate changes. Schmorl's nodes in the superior endplate of L3. L3-L4 and L4-5 degenerative disc disease are seen. There is an L4-5 small posterior disc bulge and small posterocentral disc herniation and L2-3 vertebral hemangiomas.


Mr. Veteran has chronic pain due to his injuries. The veteran suffers radiculopathy with pain, muscle control difficulty, tingling, numbness and weakness in the legs, likely due the sacralization of L4-L5.


Mr. Veteran suffers increased fatigability because of his chronic back pain. Standing for more than 15 minutes will make him become weak and exhausted.


There are multiple other clinical conditions diagnosed that are more likely than not secondary to or aggravated by the primary back condition(s).


The veteran takes numerous medications for both the primary condition as well as secondary conditions that are aggravated by said primary back condition. (Medicines and secondary conditions are listed separately.)

The veteran is not a likely candidate to be rehabilitated.


After examining Mr. Veteran, his chart and medical records it is my opinion that Mr. Veteran is totally and permanently disabled due to the above discussed back condition. The veteran can not hold gainful employment as a result of the injury he sustained while in the military. It is also my opinion that it is more likely than not the that the physical traumas suffered during the veteran's military service as noted in his record (description of events and dates) caused, contributed to and aggravated the totally disabling back condition(s).


Respectfully,

Dr. VA Physician, MD

Diplomat of the American Board of Internal Medicine


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