Nexus Letter Example

VA Disability

Advocate’s Example Medical Nexus Opinion Letter


Dear Dr. Jones:

I represent Ms. Smith in her claim for veteran disability benefits. I am writing this letter to request a medical nexus opinion regarding her back condition. While serving in the Navy, Ms. Smith fell down a flight of stairs during a sexual assault.

She was treated for back problems following the attack. Her service medical records found details of the fall and treatment during the service.

Since her 1988 discharge, Ms. Smith’s back problems have been treated by a rheumatologist at the VA Medical Center. Treating doctors at the VA facility have diagnosed Ms. Smith with the following conditions:

  • Cervicalgia with radiculopathy across both shoulders;
  • Lumbago with radiculopathy down both lower extremities;
  • Bilateral SI joint arthralgia; Myalgia, middle fibers of both trapezius muscles.

Ms. Smith indicated that you would be willing to review her records and provide an opinion regarding the cause of her back conditions for her VA disability claim. 

It is my belief that Ms. Smith’s fall down the flight of stairs during her attack caused her current back condition. If a medical expert determines that it is “as likely as not” that Ms. Smith’s current back condition is linked to her in-service fall. Then her current back disability will be considered service-connected, and her claim for benefits compensable. 

After reviewing the veteran’s medical records, please answer the following questions: 

  1. Is it “as likely as not” that her current back condition is linked to her fall down the flight of stairs during her attack in service?
  2. What are the reasons and basis for your opinion? The reasoning for your opinion is as important as your opinion.

Therefore, please indicate the documents you reviewed to reach your opinion and the facts you base your finding on. I have attached a copy of Ms. Smith’s disability claims file (C-File), which includes her service and post-service medical records.

It is essential to note in your opinion that you reviewed Ms. Smith’s claims file. The veterans’ disability benefits system is unlike other legal proceedings in which medical opinions are requested. Please note that relevant portions of the claims file have been highlighted for convenience.

If you choose to assist Ms. Smith, you will not be called to testify in court proceedings or depositions. Your opinion cannot be directly challenged, and you cannot be cross-examined.

If you believe additional information may be helpful to this claim or have questions regarding this request, please contact me at your convenience.

Thank you for assisting Ms. Smith in pursuing the veterans’ benefits she earned.

Very truly yours,

Linda Agent,

VA Accredited Claims Agent ID#


M21-1 Part V Subpart ii Chapter 1 Section A.1.i. Standards of Evidentiary Proof

Note: The application of standard of proof is qualitative, not quantitative. The question is weight or persuasiveness of the evidence and not the number of items of evidence. Evidence is not necessarily in relative equipoise when the number of acceptable items of evidence tending to support a fact is equal to the number of items tending to not support a fact.  

The table below describes the different standards of evidentiary proof. 

As likely As Not



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