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How VA Nexus Letters Can WIN Your VA Disability Claim!

(air whooshing) – Alright guys, today’s topic, Nexus letters, medical nexus letters and one step further to that, independent medical nexus letters. Okay, sometimes referred to as an independent medical opinion, a nexus letter, a nexus statement, a nexus opinion. They all mean the same thing. They’re all one in the same. Why do you need a nexus letter? Let’s start there first. Okay, let’s talk about why you might need a medical nexus letter. So remember, there’s three
things under the law. Okay, if you believe you are deserving a VA disability compensation
benefits by law, you have to meet three things. Okay, number one, you must have a medical diagnosis of a
disability or a condition. And that must be documented
in a medical record. Okay, I’ll say that again, you have to have a medical diagnosis of a disability or condition and that’s gotta be documented somewhere. Your service treatment records meaning your active duty military medical records, regardless of what branch you’re in, you should have either been given a huge packet when you left or if you were fortunate enough to separate or retire after 2005. You should have some
electronic medical records. okay, those are called service
treatment records by the VA. Okay, you don’t have a diagnosis in there, you’re screwed. Okay, however, there’s hope okay, because you can also have a diagnosis in VA medical records. Okay, VA treatment records
or any private records. Okay, now the reason this is important, is a lot of vets we serve are older. Okay, you’re Korean War vet, you’re a Vietnam vet. You’re a Gulf War vet, you were in prior to service treatment
records going digital. Okay, so you don’t have electronic copies of your service treatment records or maybe the records you do have are about this big with no, you know, diagnosis of any conditions, not even subjective
complaints of sleep apnea, migraines, PTSD, back
condition, plantar fasciitis, GERD, right, IBS,
whatever the condition is, there’s nothing, okay? I’m telling you right now, if you file a standard
VA disability claim, okay and you don’t have your service treatment records or your service treatment
records are incomplete and you don’t have a diagnosis of disabilities or conditions. I can guaran-freakin-tee you, you are gonna get denied. I can guarantee it guys, it’s a recipe for disaster. So you don’t have to have your service treatment records by the way, but you need to have some proof. Okay, in a competent, credible objective medical record. Service treatment records, VA medical records, private records, okay, you can go get a diagnosis from a private physician, right? Maybe you go to an ER, maybe you’ve got private insurance through your current employer and you have a primary care physician at a facility, maybe
you’ve got a specialist that you see, maybe you’re going to private psychologist or
psychiatrist for therapy. Okay, that’s okay too. But you gotta get copies of those records because you’re gonna need them to submit a substantiating evidence of the medical conditions you suffer from in support of your claim, okay. All right, so that’s number one, gotta have a medical diagnosis. And by the way, if you don’t have one and you can’t get one, we have a medical doctor on our team. Okay, he’s an emergency
medicine specialist, dude is an unbelievable, he’s amazing. Okay, he’s a medical doctor, he can actually diagnose you, as long as you go through an examination with him. Okay, so we talked about number one, medical diagnosis, number two, the nexus. Okay, if you’ve never heard the word nexus before, I want you to just say it out loud right now, nexus. Brian, the nexus. Okay, nexus is a fancy term that simply means link. It means that there’s a logical link or connection between something that happened in your service and something you’re suffering from today. Okay, so think of it this way. Something A happened, maybe it’s event A and because of event B, excuse me because of event A, you are now suffering from condition B, okay, this happens, it led to this, okay. If you picture those two things like this and there’s a straight
line connecting them, that straight line is the nexus. That’s the logical link or the connection. Okay, now by law codified
in federal law 38 CFR in order to be eligible for VA disability compensation
benefits under the law, a disability that you suffer from today, must have been caused or made worse by your active duty military service. Okay, so I said caused, meaning the military is the reason you have sleep apnea. Maybe the deployment is
the reason you have PTSD, okay, caused your
condition or made it worse. Okay, that’s what’s
referred to as aggravation. Okay, so for example, let’s say you came into the service with flat feet, pes planus, right? Maybe you had a waiver. But you came in to the military with a pre-existing condition, right, pre-existing flat feet. You had it before the service. Okay, well, they’re probably not gonna say that the military caused the flat feet, because you already have it, right. Military wouldn’t cause the flat feet because you already have on a record that you had to get a waiver to come in to service with flat feet, right? However, just because you have flat feet or pes planus or bunions or foot deformities or
calcified heels spurs, does not mean there’s any pain, right. Functional limitation or loss. There’s no limitation of flexion, there may not be even any pain, right? So in that case, you probably get service connected at zero percent. If you went for like, you know, plantar fasciitis or
pes planus or whatever. Okay, however, you came into the service with flat feet. You had no issues until you wore those dang
stupid black combat boots all over the place with no insoles, including multiple combat tours, right? And maybe you developed severe foot pain and heel pain, plantar fasciitis, whether it’s unilateral or bilateral and you developed that
because of your service, your job, your function, a deployment, a training incident. Okay and now you’ve got that severe pain, right? Well, you now qualify for VA disability benefits under the law, because the military aggravated the pre-existing condition. Okay, that’s what the made worse part of the nexus statement of the law means. Okay, the nexus section of the law. That’s what aggravation is. The military service made it worse. It didn’t cause it, but made it worse. Okay and then of course, there’s also secondary service connection. And what that means is a disability that you suffer from today, caused or made another
disability condition worse. Okay, so let me give you an example. We know medically that almost the entire muscular skeletal system is connected, right? Your body is a big system that works together. So for example, if you’ve got major issues with a lumbar strain, right, which is a back condition. May be you’ve got a lumbar strain that your service connected for at 10%, you’ve got some pain, you’ve got a little limitation a range of motion, but that lumbar strain is causing you to have major issues with your knees. Okay, maybe major issues with your feet, maybe major issues with your neck, a cervical string, okay? If you’re already service connected for that lumbar strain in your back at zero percent or higher, you can file a secondary
VA disability claim for the neck, the knees,
the hips, the feet, the shoulders, the arms. To say that my service connected lumbar, caused or made all of these other conditions worse in my body, right? So they’re not directly related to your active duty military service. They’re the result of they were caused or made worse by a current
service connected disability in your body, guys and here’s a secret tip on secondary disability claims in secondary service connection. Almost anything in the human body can be connected to something else. Entire human body is a
big system with components that all work together. If any one thing goes or breaks or hurts, it’s probably gonna affect something else. Okay, so I want you to really be thinking about that. One we see all the time is obstructive sleep apnea, secondary to mental health conditions. Right, especially PTSD. There’s a way to do it. Okay, we can help you do that inside of VA Claims Insider Elite, okay. Now for step two, if you’ve already been denied service connection before, okay, you’ve already filed these either as a primary disability for
direct service connection or maybe you’ve already tried obstructive sleep apnea secondary to PTSD. You’ve already tried connecting your feet to your hips, right or your back to your neck or your GERD to your IBS, right or your migraines to your PTSD. You’ve already tried those connections and you’ve been denied, right. Or maybe you haven’t tried yet, but now what you’re hearing from me, you’re like light bulb goes on. Holy crap, Brian, I think I qualify for a lot of stuff now. How do I do that? Okay, component to, pillar to the nexus part of the law is the most common reason why veterans disability claims are denied. I’m gonna say that one more time. Okay! (laughs) Your inability, the veterans inability to prove the logical link or connection, the nexus between either
the primary disability in your service or the
secondary disability and the condition you’re
trying to connect it to. Okay, your inability to prove that with objective medical evidence on an at least is likely is not basis. Okay, which I’ll talk about in a second. Because you couldn’t prove it or because you got a horrendous, terrible crappy sucky, garbage C & P examiner. You were denied service connection, that’s the most common
denial reason we see. Okay, denial of service connection, right. So if you log into eBenefits, you log into and you see things in there that say not service connected. That’s what that means. That means the VA denied
you service connection. Okay, I have one in my file. We’ll talk about that real quick. Because of an incident that happened in Afghanistan as well
as some other issues as a hockey player at the academy with concussions and migraines. There was some concern from one of the doctors that there could be mild TBI, a traumatic brain injury. I don’t think I have a TBI and never did. I balked at it. I said I don’t have a TBI. I don’t wanna do any exam. They sent me in for an evaluation, right. They pulled it out, my VSL actually filed back in 2012. A primary disability for TBI. I did not have a diagnosis. I don’t think I have TBI. I had no objective evidence I had TBI, I don’t even know why they went for it. Okay, but the TBI was filed on my behalf and it came back is not service connected. Okay, which it should have been, cause I didn’t even
have a diagnosis of TBI. Nor did I think it was related to service even if I would have had a TBI. Okay, so that’s an example of something that maybe correctly ended up not service connected. Okay, but how many times do you have things in your file that say not service connected when you go, wait a second? I was a flight line engine mechanic for eight years and you’re denying service connection for the ringing in my ears for tinnitus, are you freaking kidding me? Right I mean, your MLS right there is on the list, right, of the likelihood of noise exposure, right. Loud noise exposure. So hearing loss, tinnitus, if you’ve been denied for something like that, good lord, refile it again, with a medical nexus opinion. Okay also called a medical nexus letter. Okay, nexus letters. What is a medical nexus letter? Let’s talk about this for a second. A medical nexus letter, I’m gonna read this. This is a definition by the way that I made up. Okay, I actually spent a lot of time crafting this one sentence. But the reason I did this is ’cause I didn’t really find a good definition of
a nexus letter online. Okay, what is the VA nexus letter? What is an independent medical opinion? What is a medical opinion? Right, which we’ll talk about the difference between an independent medical opinion and a medical opinion, because there is a difference. Here is the definition
of a VA nexus letter. Okay and don’t worry, you can watch the recording or read our blog post. A VA nexus letter is an
evidence-based document, prepared by a qualified
medical professional, such as a PAC, okay, so a certified physician assistant or an MD, a medical doctor that helps to establish a connection between the claimed in-service disease or injury and the veterans current disability. Okay again, you have to establish a connection medically, okay, medical etiology, a medical connection between something you’re claiming and the
disability you have. Okay, so let me explain
this in plain English. Let’s say I have migraine headaches, I’ve got severe prostrating
migraine headaches and I filed for it a couple years ago and the VA denied me service connection. Right, here’s the dial,
there’s no evidence in the veterans active duty
service treatment records of any diagnosis of
headaches or migraines, no subjective complaints of headaches or migraines, okay? So you get denied ’cause you didn’t know any difference and here we are and now you’re going, man I do have severe prostrating migraines. I do have a diagnosis now
in my VA records, okay. So you could probably
service connect that, the migraines, secondary
to something else, maybe something like
post-traumatic stress disorder, okay, maybe something
like depression, insomnia. Maybe you’re connecting migraines to GERD or migraines to sleep apnea or migraines to IBS, right. There’s tons of connections for migraines. And so if you wanna do that, though you’ve been previously denied or maybe you just wanna do it, right, the first time. You need to get a nexus letter, an independent medical nexus letter from a competent and
credible medical provider. Okay, who can assist establish medically that there’s a connection
between your migraines and the other service
connected disability. Okay, like PTSD blah, blah, blah. Now notice in this definition I said evidence-based. Okay, I did not say opinion. I’m gonna say that one more time. A nexus letter is an
evidence-based document. Okay, now the provider will give their nexus opinion in a statement inside of the letter, which is crucial, okay. But that’s not the most important part. The most important part is the evidence, the case studies, the BVA case law, the medical research, the veterans own treatment records and symptoms, the result of the independent medical examination that are then put together in a fact-based order that leads the writer to a conclusion. Okay, that could say
something like in conclusion, it is my medical opinion, right that the veterans, obstructive sleep apnea is at least is likely is not due to their service connected post-traumatic stress disorder, specifically, the side effects of the medications they’re taking to manage their depression, anxiety, anger, blah, blah, blah, blah, blah. Okay and you heard me say it again, at least is likely is not, okay, that means tie goes to the runner. Okay, so for example, if anybody’s a baseball fan, right, if you’re running, you just hit a ground
ball toward third base and you start sprinting towards first, for me, I don’t spend any more, it’d be more like a half-hearted limp. Okay, I’m limping to first base, right? If my foot hits the
bag at the exact moment that the first baseman catches the ball, okay, the umpire is gonna go, safe, right? Tie goes to the runner, it’s the same concept, okay? It’s codified in 38 CFR, it’s called the benefit of the doubt rule. Okay, some people call it the benefit of the doubt doctrine. It’s been defined differently. But what that means is when all things are equal, okay, there’s an equal weighting of positive evidence in the favor of the veteran and negative evidence
going against the veteran. The tie, the benefit goes to the veteran. Okay, that’s the benefit
of the doubt doctrine. Okay, why are nexus letters so effective? Nexus letters are so effective at helping you prove the nexus of service connection
because they influence the compensation, pension
examiners opinion, okay, most of the time and then it can also influence legally and within the regulation, the VA raters final disability decision. Okay, because there’s again, there’s that complete
credible medical evidence in the nexus letter to help you establish service connection, on an at least is likely is not basis. Now the question we get all the time is Brian, got it? I know what a nexus letter is, but my VA doctor sucks and won’t write one. I don’t have a private doctor that I like, I don’t know how to structure this thing. How do I get a medical nexus letter? Guys, that’s what we do. Okay that is why I
founded VA Claims Insider. The secret to VA disability
compensation claims is medical evidence in the form of disability benefit questionnaires and qualified credible, competent medical nexus opinions, okay. That’s the linchpin. That’s the secret. That is how you are going to get a higher VA rating than last time. It’s how you’re gonna
prove service connection. It’s how you’re gonna prove the severity of symptoms. It’s how you’re gonna prove you have a diagnosis. Okay, that’s the secret sauce. Okay, now you can get them one of two ways, you can hopefully, have one of your own private providers, do nexus letters for you. That’s one way and you can use our templates. You can ask a VA doctor, good luck, okay or you can get your butt inside of VA Claims Insider Elite and go you know what, it doesn’t cost me any money to start. I’m gonna give these guys a shot. I am underrated, I am stuck, I am sick of fighting the VA, I have been denied service connection. You need a nexus letter? Okay, how do you write a winning VA nexus letter? Okay, I put together these four tips based upon our experience, what we see, our medical training. Okay, how do you write a winning VA nexus letter? Number one, the very best medical nexus letters guys, they’re short and sweet. They’re short, factual to the point and evidence-based, not just opinion-based. It’s evidence-based. Okay, number two, the doctor, the medical professional, the PA, the MP, whoever the MD, cites and has listed applicable medical research and studies and case law to back up their opinions. Okay, so that they’re not just baseless, opinions, they’re fact or they’re at least reasonably
linked with a conclusion. Okay, that could lead the reader to go, yeah, that makes sense. Okay, medically makes sense. There’s a connection between condition A and condition B. Okay, so in your nexus letter, you’ve gotta have some applicable medical research studies. How do you get those? Go to for free, guys, it’s a free government website. You can search for all kinds of medical connections. That’s your free hack for today. Go to you can do your own research as well up front, on medical connections between conditions based upon the latest and greatest research, okay. In part three of the nexus letter, the doctor must express their opinion, okay, this is where that opinion part is important. About how they reached the conclusion of their next statement with at least is likely is
not, okay that’s 50-50. There’s also more likely than not, that means there’s a greater than 50% chance. Okay, but the minimum threshold you need, is at least is likely is not. Okay, that’s in part three. And then in part four, the doctor must sign and date their letter or sign and date their name and they have to list their medical credentials. Okay, hey, I’m a, you know, board certified, whatever,
sleep specialist. Okay, I’m a certified
physicians assistant. Okay, so again, the best nexus letters, they’re short, they’re sweet, they’re factual, they’re evidence-based. They talk about the how and the why, that the doctor reach their conclusion. Now, guys, I’ve heard of nexus letters being 50 to 60 pages long. It’s a bunch of garbage. Okay, less is more. Less is more, if you give the VA raters too much, guys are setting yourself up for disaster. They’re very busy people, tell them exactly what
you want them to know. Okay, you make their lives easier, guess what’s gonna happen? You become infinitely more likely to get the rating you deserve in less time, right? Man and my buddy Rich Szymansk such a beautiful human being dude. One of our best, Richard the GOAT Szymanski, he said you know what? You give them exactly what they need. You probably just made their day. that VA rater is gonna get to go home early today, right? So think about this guys. I talked to VA raters weekly. Okay, fellow service-disable veteran just like you and me who work at the Department of Veterans Affairs as VA rating officials. Okay, whether they’re VSR or RVSR, we talk all the time, about things that are going on. Okay, that’s part of why we call ourselves VA Claims Insider. We get information that nobody else does and we’re sharing it with you freely and openly. Okay, guess what? The average VA rater is a GS-12. Okay, General Schedule,
government civilian, GS-12, they make about, you know, 60 to 80,000 bucks a year. They work their asses off in a low performing culture at the VA, unfortunately. And they’re measured on everything. They’ve got quality metrics on every fricking keystroke that they make. Guys, it’s a high pressure environment for these raters, right not to mention the quality checks, the after actions, all their decisions are being checked, they have to maintain certain accuracy levels over time. It’s a stressful job. Okay, well, how happy do you think that person is gonna be, who’s expected to produce 15 different rating decisions for 15 different veterans per day, if you send them 2000
pages of medical records, (laughs) They gotta go through it all guys. It’s gonna delay the claim, it’s gonna highly likely result in a denial or you being underrated, okay or it’s gonna take forever. The easier you can make it for the VSR and the RVSR, the rater at the VA. The easier you can make it, give them exactly what you want them to see. Here’s my diagnosis. Here’s my applicable nexus letter. Here’s my personal statement that backs up all these things. Maybe you have to have a buddy letter to substantiate symptoms. Here’s why I believe this is this. Here’s why I think this is service connected. Guys, guess what’s gonna happen? You think they’re more likely to approve that claim or deny that claim? Let’s see, are they more likely to approve that claim or deny that claim. Approve, approve, approve, approve. Yeah, you’re right. So we talked about the nexus letter by the way I have a great blog post out there, if you go to as we’re pumping out unbelievable original content every single day. Okay, there’s a post right there, talking about the three tips to find the best nexus letter doctors. I talk about how to write a VA nexus letter, how to write a winning VA nexus letter, the statements of opinion, okay, all of that stuff. So if you want absolutely you wanna go in depth, go to and read some of our free content. Okay, I do wanna address one other thing before I take some
questions from you guys. Okay, because I know we bash VA doctors a lot. Okay, VA doctors work for the VA, they are civil servants and they work for the Veterans Health
Administration, the VHA. Okay, many of them are very good doctors. Okay, they are. I’ve actually personally had great treatment at the VA. And I’m very thankful for that. And so one thing I found that was really interesting, okay. And a lot of vets wanna know will VA doctors write nexus letters for veterans? Okay and the answer is no. Most VA doctors will
not write nexus letters. So here’s part of the reason, part of it I think is they just don’t know, right? They’re lazy, they don’t wanna get bogged down with paperwork. They don’t understand their real role and job. They just wanna treat patients and not provide documentation. Okay, got it. But some of them believe that under the law and according to VA regulation, that a VA doctor is considered hired in the service of VA, right. Hired in the service of VA and that according to their own regulation, they do not qualify. They’re not appropriate medical experts to provide an independent opinion. Okay, it’s almost as if they see a little bit of a conflict. Now, I disagree with that. But I’m telling you what some of them believe, is that I could do this for you veteran, but I’m not truly an independent examiner. Right, I’m biased, perhaps because they’re hired in the service of the VA. Okay, so that’s something
to think about is, there is some basis for why the VA doctors tell you that, you know, I can’t do this for you. Okay, whether you agree with them or not. So chances are again, you’re gonna need to find a private medical provider, private independent medical provider to do these letters for you. Okay, again, that’s what we do at VA Claims Insider Elite. You need medical nexus letters, you need DBQs. Get your butt in our membership program. You can start free today at You can also open up
the YouTube description. There’s a whole bunch of links and resources in there as well, okay. Brian Reese here, the VA Claims Insider Air Force service-disable vet, I’m out from Austin, Texas. I’m gonna leave you with one thing, boom!

Cesar Sullivan

6 thoughts on “How VA Nexus Letters Can WIN Your VA Disability Claim!

  1. ✔️Join VA Claims Insider Elite, get instant access to the ELITE Experience Portal (EEP) and $13,119 worth of proprietary VA claim resources TODAY, and obtain a VA DBQ and Medical Nexus Letters:

  2. Question, I get percentage for lower back…the pain in my leg/foot is secondary and I get percentage for that…this pain disturbs my sleep…can i possibly get sleep disturbance too (2ndary). Va did diagnose, as well as a 2nd sleep study told me I got obstructive sleep apnea…no percentage on it tho…

  3. Brian you are on top of this….my service-connected knees caused my lumbar and cervical issues and with MRI's at VA and C&Ps got approved from 20 to 90 secondary……in this case the nexus was the MRIs and C&P examiners statement….I was surprised and it took about a year..

  4. Q-if you have a nexus statement and your called to a C&P exam; does the examiner write another nexus to approve or deny your claim?
    I have a ptsd-combat C&P next week and I’m a little confused on what their job is.

  5. I was granted 50% for bilateral pes cavus with plantar fasciitis. I’m going to file for secondary conditions regarding my knees, hips and lower back. Would I be able to have my Dr. draft one nexus letter and have all conditions contained in said letter? Or would he have to draft a letter for each condition?

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