What is a Nexus Letter?

A nexus letter is a powerful piece of evidence in a VA disability claim. It’s a written medical opinion that draws a clear, direct link between a veteran’s current medical condition and their military service. For many veterans—especially those filing for mental health conditions—a nexus letter can be the deciding factor between an approval and a denial.

What Is a Nexus Letter in VA Claims?

The VA requires proof that your disability is connected to your service. This connection is called “service connection.” Without a nexus letter or an equally strong medical opinion, the VA may claim that your condition isn’t related to your time in the military.

A well-written nexus letter removes ambiguity. It explains—in plain, professional terms—why your diagnosis is at least as likely as not caused or worsened by your service. That phrasing is crucial, because it matches the VA’s evidentiary standard. When your nexus letter addresses both your diagnosis and its service connection in VA-aligned language, it strengthens your claim and increases your chances of approval. For veterans who have faced repeated denials, it can be the turning point toward finally securing benefits.

Who Needs a Nexus Letter?

Not all claims require a nexus letter, but many veterans benefit from having one. You should strongly consider getting a nexus letter if:

• You’re filing a first-time claim and lack extensive in-service medical records.
  
• You’re appealing a VA denial that stated “no evidence of service connection.”
  
• You have a condition diagnosed after service, but you believe it was caused by or aggravated during your time in the military.
  
• You’re filing a secondary claim, such as depression related to chronic pain from a service-connected injury.
  
• For more guidance on secondary mental health claims, see our blog “Filing A Successful Secondary Mental Health VA Claim For Service Connection.”
  
• Your C&P (Compensation & Pension) exam minimized your symptoms or failed to clearly link your diagnosis to service.
• Your symptoms have worsened significantly, and you are seeking increased benefits.

For mental health claims—PTSD, depression, anxiety, and similar conditions—a nexus letter can be critical, because the connection between service and symptoms is often more complex to document.

Essential Elements of a Strong Nexus Letter

A strong nexus letter is not a casual note from your doctor—it’s a formal medical opinion built to VA standards. It should include:

• Veteran’s identifying information (name, date of birth, last four of SSN).
  
• Doctor’s credentials (specialty, licensure, and experience).
  
• Review of the veteran’s records (service medical records, personnel records, private treatment notes).
  
• Clear diagnosis using DSM-5 criteria for mental health conditions.
  
• Service connection statement using VA-aligned phrasing such as “at least as likely as not” (50% probability or greater).
  
• Rationale explaining how the veteran’s service caused or worsened the condition.
  
• Discussion of symptom severity and impact on daily functioning.
  
• Signature and date on professional letterhead.
  

For example, a psychologist writing for a PTSD claim should outline the veteran’s in-service traumatic event, link it to current symptoms, and explain that alternative causes are less likely.

How to Secure Strong Documentation for Your Claim

Veterans can get a nexus letter from a qualified medical provider who understands VA claims. Here’s how to start:

1. Gather your records – Include all relevant service treatment records, VA medical records, private treatment notes, and any lay (e.g., personal or buddy) statements.
   
2. Choose the right provider – Look for someone experienced in writing VA-ready opinions, such as a psychologist specializing in veteran mental health. Searching for “nexus letter psychologists near me” can help, but always verify credentials and VA experience.
   
3. Schedule a comprehensive evaluation – The provider should conduct a full diagnostic interview, not just a brief checklist.
   
4. Request a VA-aligned format – If the provider is not familiar with VA requirements, share sample nexus letters or request that the provider follow the format outlined below.
   

VMHA’s providers, for example, conduct full evaluations and write nexus letters specifically designed for VA review, ensuring they meet evidentiary standards.

Is a Nexus Letter Required for All Mental Health Claims?

No—some veterans win claims without a nexus letter, especially if their service medical records already provide a clear link to their condition. However, many mental health claims are denied due to “no evidence of service connection” or “condition not severe enough for rating increase.” In these cases, a nexus letter can bridge the gap and provide the VA with the documentation they need.

Given the high denial rates for mental health claims, obtaining a nexus letter is often a smart investment.

Can a VA Doctor Write a Nexus Letter?

Yes, but it’s rare. Some VA doctors will provide medical opinions for their patients, but many avoid writing nexus letters due to internal policies or workload. If your VA provider is unwilling, you’ll need to seek an independent provider.

Independent Medical Opinions (IMOs) from non-VA providers can be especially persuasive because they may include a deeper review of your records and are free from VA internal pressures.

For more on how IMOs can help your claim, see our article “Independent Medical Opinions Increase Your Chances of Success.”

Nexus Letter Psychologists Near Me

Finding the right psychologist is essential. Look for providers with:

• Experience writing VA-compliant opinions.
  
• Expertise in diagnosing DSM-5 mental health conditions.
  
• Understanding of VA rating criteria.
  
• Strong documentation and report-writing skills.
  

VMHA’s team specializes in mental health nexus letters and offers telehealth options for veterans across the country.

Format of a Nexus Letter

While there’s no single mandated format, here’s a VA-friendly structure:

1. Heading – Doctor’s name, credentials, contact information, date.
   
2. Veteran Information – Name, DOB, last four of SSN.
   
3. Statement of Review – List of records reviewed.
   
4. Diagnosis – DSM-5 diagnosis (for mental health conditions).
   
5. Service Connection Opinion – “It is at least as likely as not that the veteran’s [condition] is related to their military service.”
   
6. Rationale – Evidence-based explanation.
   
7. Functional Impact – How symptoms affect daily life.
   
8. Signature – Doctor’s signature and professional seal.
   

Sample Nexus Letter

Below is a condensed example for educational purposes only:

Date: [MM/DD/YYYY]
To Whom It May Concern:
I am Dr. Jane Smith, a licensed clinical psychologist with 15 years of experience evaluating veterans for mental health conditions. I have reviewed the complete service treatment records, personnel file, and current medical records for [Veteran Name], DOB [MM/DD/YYYY], last four SSN [####].

Based on my review and a comprehensive clinical evaluation, it is my medical opinion that it is at least as likely as not that the veteran’s diagnosed PTSD is directly related to his military service, specifically the in-service incident documented on 2025 in [location].

My rationale includes: documented in-service stressor, consistent symptom presentation, absence of pre-service mental health conditions, and current functional impairment in occupational and social settings.

Signed,
Dr. Jane Smith, PhD, Licensed Clinical Psychologist

Steps to Secure a Strong Nexus Letter

1. Identify the Gaps – Review your claim file, or if you’ve already filed and have been denied, your denial letter, to see whether service connection is missing.
   
2. Choose the Correct Provider – A psychologist familiar with VA claims can make a major difference in your claim success.
   
3. Provide Complete Records – Give the provider everything they need for a thorough review.
   
4. Request VA-Aligned Language – Insist on phrases like “at least as likely as not” in the opinion.
   
5. Include Functional Impact – Show how the condition affects work, relationships, and daily activities.
   
6. Submit with Your Claim or Appeal – Pair the nexus letter with other evidence for maximum effect.
   

For detailed information on appeal options, visit the VA’s official decision review page.

Final Thoughts

A well-crafted VA disability claim nexus letter can be the bridge between a denied claim and an approved one. While not required in every case, it can be a decisive factor—especially for mental health claims where service connection isn’t immediately obvious.

At VMHA, we specialize in comprehensive Independent Medical Opinions that include VA-ready nexus letters that combine thorough evaluations with precise, evidence-based writing. If your claim needs stronger service connection documentation, don’t wait for another denial. Take control of your claim and ensure your story is supported by a clear, professional medical opinion. Veterans fight hard for their benefits—make sure you have every advantage when presenting your case.