How to Ask Your Doctor for a Nexus Letter

Ask your doctor whether they are willing to review the relevant records and give their own medical opinion about the connection. Do not ask them to sign a conclusion you wrote, and do not make the request depend on the answer being favorable.

A short request with an indexed packet is easier to say yes to than a stack of records and a request to "help with my VA claim."

Start with one medical question

Write the question in neutral terms. For example:

• "In your medical judgment, is my current right shoulder condition related to the documented injury in June 2011?"
• "Did my service-connected ankle condition cause, or worsen beyond its natural course, my current hip condition?"
• "Is my diagnosed sleep disorder at least as likely as not worsened by my service-connected asthma?"

The question names the current condition and the proposed connection. It does not dictate the answer.

A plain request script

You can say:

I am preparing a VA disability claim and need a medical opinion about whether my current condition is connected to the history in these records. Would you be willing to review a short, indexed packet and decide whether you can give an independent opinion? I understand you may disagree with the proposed connection or need more information. If you can give an opinion, VA needs the medical reasoning and the records you relied on, not only a conclusion.

Bring a review packet, not your entire archive

Include:

1. A one-page request letter with the medical question.
2. A timeline of relevant service, symptom, diagnosis and treatment dates.
3. The specific service records, medical notes, test results and earlier opinions that bear on the question.
4. The facts that cut against the connection, such as a later injury, a treatment gap, a risk factor or an earlier negative opinion.
5. Any research you think applies, with a one-line note on why and on its limits.
6. A blank page for the clinician's questions and requests for missing records.

Use page references. "March 2024 sleep clinic note, page 18" is more useful than "somewhere in my records." For help choosing the documents, see what medical records a clinician should review.

Can a VA doctor write a nexus letter?

Yes, but VA policy frames it as something a VA clinician may choose to do. VHA Directive 1134, amended July 8, 2025, requires VA health care providers, when asked, to help complete forms and to provide medical statements about your condition and how it affects your function. For opinions about what caused a condition, the directive says providers "who wish to provide medical opinions that state causality" must include clear and specific rationale citing evidence. It also notes that VA providers often do not have your military medical records and that service connection itself is decided by the Veterans Benefits Administration, not by the treating provider.

Three practical points from the same directive:

• A VA treating provider may complete a Disability Benefits Questionnaire (DBQ) for a condition they already diagnose and treat. The directive recommends that your treating provider not complete a mental health DBQ, to protect the treatment relationship.
• Each VA medical facility must have a process for reconsideration when a provider declines to write a medical statement or complete a form, and a Medical Statements and Forms point of contact. Ask the facility for that contact if you are unsure where to start.
• Facilities must have a process to tell you when a statement or form cannot be completed within 20 work days.

Read the directive on VA's publications site if you need the exact wording.

Who writes the opinion, and what Board data shows

In Claim Raven's analysis of Board of Veterans' Appeals decisions (measured September 2, 2026, in condition records), opinions from a treating physician were associated with a 78.5% favorable share (2,613 records), private independent examiners with 73.8% (6,827), and VA examiners with 36.9% (35,160). These are Board appeal outcomes in already-disputed claims, so they describe patterns, not your odds. The three groups differ in many ways besides who wrote the opinion, including which claims reached the Board, so the gap does not measure the quality of any one kind of clinician.

Credentials matter, but they do not carry a letter on their own. In one Board case, two chiropractor letters received no probative weight because they contradicted the chiropractor's own treatment records and showed no sign of a records review. In another, a private physician assistant's opinion carried a neck claim: the Board found its rationale sound and consistent with the other evidence, and no medical opinion in the file disagreed. Ask a clinician whose training fits the question, and judge the letter by whether it fits the record.

If your doctor says no

A refusal can mean several things:

• The practice does not write opinions for benefits claims.
• The clinician does not have time for a record review.
• The question is outside their expertise.
• The records are incomplete.
• The clinician does not support the proposed connection.

Ask which reason applies. The one you can often fix is incomplete records. If that is the reason, ask a specific follow-up: "Which records would you need to see before you could evaluate this, and would you review the question again if I bring them?" Write down what they name, gather it, and return with an updated index. If the reason is office policy or scope, you can look for another qualified clinician. If the clinician does not support the connection, do not press them to change a medical conclusion.

If you are considering a paid provider instead, Claim Raven's reviews of nexus letter providers cover individual companies' prices, refund terms and limits.

What the final opinion should let a reader check

A reader should be able to identify the clinician and their credentials, the question, the records reviewed, the relevant medical facts, the conclusion and the reasoning. It should address the facts that cut against the conclusion, and it should be signed and dated.

Raven Nexus can organize selected records, a request letter and a review checklist into a packet for your clinician. A free account includes one starter assessment; full drafts need Standard or Plus. It does not include a clinician, an appointment or a signature, and Claim Raven has a commercial interest because it sells the tool.

Asking for a nexus letter: common questions

Sources and scope

Checked September 23, 2026: VHA Directive 1134(3), Provision of Medical Statements and Completion of Forms by VA Health Care Providers, dated November 28, 2016 and amended July 8, 2025; VA evidence requirements. Author-type figures come from Claim Raven's Board decision analysis measured September 2, 2026. A private clinician may have their own documentation, fee and office-policy requirements.