The VA nexus letter template, free to copy
A nexus letter is a medical opinion connecting your condition to your service. It is the piece most claims turn on, and the piece most often written in language VA discounts. Below is the whole letter, blank and ready to hand your doctor — copy it, or download it for Word. Underneath, what each section is doing and why raters look for it.
The complete template
Everything in brackets is for your doctor to fill in or delete. They should print it on their own letterhead and sign it. You do not mail this yourself — it goes in with your claim as evidence.
[CLINIC LETTERHEAD — provider name, credentials, license number,
address, phone]
[DATE]
Re: [VETERAN FULL NAME]
VA File Number / SSN: [NUMBER]
Date of Birth: [DATE OF BIRTH]
To Whom It May Concern:
I am [PROVIDER NAME], [DEGREE], licensed to practice in [STATE],
license number [NUMBER]. I have treated [VETERAN NAME] since [DATE].
[Or: I evaluated [VETERAN NAME] on [DATE].]
RECORDS REVIEWED
In forming the opinion below, I reviewed the following: [service
treatment records; DD-214; VA treatment records dated [RANGE];
private treatment records from [PROVIDER]; [IMAGING OR TEST] dated
[DATE]; and the veteran's own account of [EVENT]].
DIAGNOSIS
[VETERAN NAME] has a current diagnosis of [CONDITION], confirmed by
[EXAM FINDING, TEST, OR IMAGING] on [DATE].
OPINION
It is my medical opinion that [VETERAN NAME]'s [CONDITION] is
at least as likely as not [caused by / incurred during /
aggravated beyond its natural progression by]
[THE IN-SERVICE EVENT, EXPOSURE, OR SERVICE-CONNECTED CONDITION].
RATIONALE
[Two to four sentences giving the medical reasoning. Name the
mechanism connecting the two. Point to what in the records supports
it — onset timing, continuity of symptoms since service, findings on
examination. Address the most obvious alternative explanation and say
why it does not account for this presentation.]
I am available to provide further information or clarification if
that would assist in adjudicating this claim.
Sincerely,
______________________________
[PROVIDER NAME], [DEGREE]
[SPECIALTY / BOARD CERTIFICATION]
License [NUMBER], [STATE]
[PHONE] · [EMAIL]Why each section is there
The letter is not arbitrary formatting. Each block answers one of the four things a rater looks for.
- RECORDS REVIEWEDA statement that your records were reviewed
Name the actual documents. "I reviewed the veteran’s file" is weaker than a list, because a rater cannot tell what was in it.
- DIAGNOSISA current diagnosis
State the diagnosis outright. Describing symptoms and leaving the diagnosis implied is a common reason an otherwise good letter carries little weight.
- OPINIONThe phrase "at least as likely as not"
Keep this phrase word for word. "Possibly," "may be," "could be" and "cannot rule out" all sit below VA’s standard, and a rater may read them that way.
- RATIONALEA stated medical rationale
This is the section that decides most claims. An opinion with no reasoning behind it carries little weight no matter who signed it.
The phrase that matters most
VA's standard is “at least as likely as not” — a 50 percent or greater probability. Under 38 CFR § 3.102, when the evidence is evenly balanced, the tie goes to the veteran.
That is why the wording is not a formality. “Possibly related,” “may be related,” “could be related,” and “cannot rule out” all sit below the standard, and a rater is entitled to read them that way. A well-meaning doctor who writes “it is possible this is related to his service” has written a denial.
The four things every nexus letter must do
Regardless of condition or theory. A letter missing any one of these is the most common avoidable reason a claim is denied.
- 1.A statement that your records were reviewed
VA weighs a medical opinion partly on whether the clinician actually had the evidence in front of them. A letter that does not say what was reviewed reads as an opinion formed without the file.
- 2.A current diagnosis
Service connection requires a present disability. The letter should state the diagnosis plainly rather than describing symptoms and leaving the conclusion implied.
- 3.The phrase "at least as likely as not"
This is VA's evidentiary standard — a 50 percent or greater probability. Under 38 CFR § 3.102 the tie goes to the veteran, and this phrase is what places the opinion at or above that line. Softer wording ("possibly," "may be," "could be," "cannot rule out") sits below the standard and is a leading cause of denial.
- 4.A stated medical rationale
The reasoning behind the conclusion, not just the conclusion. An opinion that gives an answer without explaining the basis for it carries little weight, no matter how well-credentialed the signer.
Pick your condition
Each guide covers the theory that condition is usually claimed under, what the letter has to establish beyond the universal four, and the specific ways these letters get discounted.
Before you pay anyone for a letter
- ›You may not need one. If a presumption covers your service and condition, VA connects it without a medical link. Check that first — it is free and takes a minute.
- ›Your own treating doctor can write it. They already know your history, and a clinician with a treatment relationship is well positioned to give an informed opinion.
- ›A VSO can help for free. DAV, VFW, and the American Legion represent veterans at no charge and are the best deal in this system.
NexusVetClaims provides software, not legal representation or medical advice. We are not VA-accredited and never take a percentage of your benefits. A nexus letter is a medical opinion — only a qualified clinician who has evaluated you can provide one. Our drafter produces the framing and legal language; the medical judgment is your doctor's.