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.

Why are Nexus Letters So Important for Claims?

The VA needs evidence to support a disability claim. While your own testimony is valuable, a nexus letter provides an objective, professional medical opinion, which carries significant weight. A strong nexus letter gives the VA the essential link they need to approve a claim by demonstrating three key elements:

• A current, diagnosed mental health condition: You must have a diagnosis from a licensed medical professional.

• An in-service event, injury, or exposure: This refers to the specific incident or circumstances during your military service that led to your condition.

• A “nexus” or link between the two: The nexus letter directly connects the diagnosed condition to the in-service event.

A strong nexus letter should include the essential link the VA needs. Without a strong nexus letter, a claim can be denied, even if you have a current diagnosis and a traumatic event from your service. The letter transforms your

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.

How To Get A Nexus Letter?

If you do need a nexus letter, selecting the right medical professional is critical to the success of your claim. The provider must be more than just a licensed doctor; they must also understand the unique aspects of a veteran’s experience and the specific requirements of the VA claims process.

Here’s what to look for:

• Qualifications: The provider should be a licensed psychologist, psychiatrist, or other qualified mental health professional. The letter will carry more weight if it comes from a specialist in the field.
  
• VA Claims Process Knowledge: The provider must be familiar with the VA’s claims process, including the specific language and evidentiary standards required. An effective nexus letter uses the exact terminology the VA expects to see, such as “at least as likely as not” or “less likely than not.” 
  
• Experience with Veterans: A provider who has worked with veterans will have a better understanding of how military experiences, such as combat, training accidents, or military sexual trauma (MST), can uniquely affect mental health. They will be better equipped to evaluate your case thoroughly and understand the nuances of PTSD, depression, and anxiety in a military context. 
  
• Thoroughness and Objectivity: The provider should be willing to conduct a comprehensive review of all your relevant records, including your service records, military personnel files, and post-service treatment records. They should be willing to provide an objective opinion based on the evidence, not just on your statements.
  
• Ethical Standards: The provider must be committed to writing an ethical and honest opinion. They should never promise a specific outcome but should provide a well-reasoned, evidence-based assessment. 
  
• Objectivity: An independent provider can give an unbiased opinion, which can make your nexus letter more credible. 
  
• Willingness to Testify or Clarify: While rare, there may be instances where the VA needs additional clarification. A strong provider should be willing to provide further information or, if necessary, testify on your behalf. 

Essential Elements of a Strong Letter

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

• 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.

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.
   

Nexus Letter Example

Below is a condensed version 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

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

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.
   

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

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

How Much Does a Nexus Letter Cost?

The cost of a nexus letter can vary significantly depending on the provider and the complexity of your case. Some providers charge a flat fee, while others may bill by the hour. Prices can range from a few hundred dollars to several thousand. Be cautious of any provider who charges a percentage of your back pay or promises a guaranteed outcome. Ethical providers will charge a flat fee for their time and expertise, regardless of the claim’s final result.

Beyond the Nexus Letter: Building a Comprehensive Case

While a nexus letter is a crucial component, a truly winning claim involves much more. You must build a complete case that leaves no room for doubt.

• Buddy Statements: Gather statements from fellow service members, friends, or family members who witnessed the in-service event or observed your mental health struggles after you returned. These statements, also known as buddy letters, add a personal touch and can provide powerful corroborating evidence.
  
• Personal Statements: Write a detailed personal statement explaining your experience. Describe the traumatic event or stressor and how your mental health condition has affected every aspect of your life—your job, your relationships, your hobbies, and your daily activities. This is your chance to tell your story in your own words.
  
• C&P Exam Preparation: The VA will schedule a Compensation and Pension (C&P) exam with a VA-appointed doctor. Before this exam, review your medical records and your personal statement. Be honest and clear about your symptoms. Do not downplay your struggles. Remember, this is not a routine check-up; it is a key part of your claim.
  
• Record Collection: Be proactive in gathering all your medical records. Do not assume the VA has everything. Request copies of your Service Treatment Records (STRs) and your civilian medical records. A complete set of records allows your provider and the VA to get a full picture of your health history.

What If Your Claim Is Denied with a Nexus Letter?

If you submit a nexus letter with your claim and the VA still denies you, do not give up. A denial doesn’t mean your claim is without merit. It often means you need to provide more evidence or a stronger argument. The VA’s denial letter will explain why your claim was not approved. Use this information to strengthen your appeal and file a supplemental claim with new and relevant evidence. At this point, it is crucial to consider a more comprehensive Independent Medical Opinion (IMO) from an independent specialist. An IMO is a more detailed report that can directly counter the VA’s reasoning for the denial and provide a more persuasive case for service connection.

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.

Here’s how our Independent Medical Opinions benefit veterans:

• Comprehensive Assessments: Our psychologists conduct in-depth evaluations to thoroughly understand your mental health condition and its specific link to your military service. This is not a quick review; it is a meticulous process that ensures all aspects of your claim are considered. 
  
• VA Claims Expertise: We know the VA claims process inside and out. We are well-versed in the specific medical evidence and terminology the VA looks for. Our nexus letters are structured to meet these requirements, significantly increasing the likelihood of a successful claim. 
  
• Clear and Ethical Nexus: Our nexus letters clearly and honestly connect your diagnosis to your military service. We provide the “at least as likely as not” opinion in a way that is medically sound and well-supported by evidence. 
  
• Strong Advocacy: We provide detailed evidence to back up the nexus in our letters. This makes your claim stronger and more persuasive. We also understand that the claims process can be a long journey. This is why we offer support for the life of your claim.
  
• Accurate Benefits: Our ultimate goal is to help you secure the most accurate VA disability rating and benefits possible. A well-supported claim with a strong nexus letter is the best way to achieve this.  

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.

Ready to get the rating you deserve?

If you need a mental health nexus letter, don’t wait. Contact us today to learn how our Independent Medical Opinions can help you secure the benefits you deserve.

Email us at info@vmhaforvets.com or call us at 214-307-2198.

Other Related Articles:

How a VA Nexus Letter for your mental Health Claim Can Make or Break Your Case?

Understanding The VA Nexus Letter For Mental Health Claims

Nexus Letter and Comprehensive IMO: How to Win Your VA Disability Claim

15