What Medical Records Should a Clinician Review for a Nexus Letter?

A clinician needs the records that answer the medical question, not every page you have. That usually means the current diagnosis, the service record or primary service-connected condition, the timeline between them, any earlier medical opinions, and the facts that could weaken the connection. Put them in a short, dated index with page numbers so the clinician can check each one.

Here is what that looks like before any explanation.

Use an index the clinician can scan

Fictional index for a left knee claim (direct theory):

The index describes what each record may show. It does not tell the clinician what to conclude, and it lists the 2019 injury and the negative opinion as plainly as the service note.

Start with the theory

For a direct theory, collect records of the in-service event, the current condition and the history between them. For a secondary theory, add the rating decision or other record showing which condition is service connected, and its treatment history. If aggravation is in question, include the earliest medical record showing how severe the second condition was before it worsened; VA requires that baseline to come from medical evidence under 38 C.F.R. § 3.310(b). A 2023 Federal Circuit decision, Spicer v. McDonough, held that VA cannot use that rule to reject a claim that a service-connected condition made another condition worse than it would otherwise be.

The core packet

1. Service and personnel records

Include your DD214 or other separation document, the service treatment records that mention the injury, symptom or exposure, and personnel records that show where you served and what duty you performed. VA lists the DD214 and service treatment records among the documents it needs for every disability claim (VA evidence page). For a secondary theory, include the rating decision showing the service-connected condition.

2. Current diagnosis and testing

Include the note, imaging, lab result, sleep study or other record that documents the current condition. If the diagnosis changed over time, include the record that explains the change.

3. Symptom and treatment timeline

Choose records that show onset, persistence, gaps, changes in severity and major treatment. The timeline can include VA records, private records and statements from people who saw the symptoms. Keep medical conclusions for the clinician.

4. Earlier opinions and examinations

Include favorable and unfavorable Compensation and Pension (C&P) opinions, Disability Benefits Questionnaires (DBQs), private opinions and the relevant passages of any decision letter. A new clinician cannot respond to a disputed premise they have not seen.

5. Facts that cut against the connection

Include later injuries, occupational exposures, medication changes, weight changes, family history or other facts that are medically relevant. Their presence does not decide the answer. Leaving them out can make the opinion easy to discount.

6. Research, if it fits the question

Provide the full citation or article, not a screenshot of a headline. Add one sentence on why it may apply and one on its limits. An association in a population does not establish cause in one person.

For a source-by-source way to find these entries, see how to find supporting evidence in your VA medical records.

Why the contrary records matter

The Board weighs whether an opinion was built on the whole record. In a February 26, 2025 decision (Citation A25017424), the Board denied service connection for a low back condition. A private medical opinion described in-service back complaints and later treatment, but it did not mention a 1996 VA examination, with X-rays, that found no low back diagnosis the year after service. The Board wrote that "the opinion does not address the negative diagnostic findings from the post-service examination," found it inadequate in its review of the evidence, and gave it minimal probative weight. The 1996 examination and a 2023 VA opinion that cited the lack of continuing symptoms received high weight.

That is the practical reason to include the records that hurt. An opinion that engages with them may still be favorable. An opinion that skips them gives the Board an easy reason to set it aside.

In Claim Raven's analysis of Board decisions, "no nexus" was the primary reason in 22.9% of about 17,100 denied condition records where a reason was classified, second only to severity not met (29.1%). These are Board appeal outcomes in already-disputed claims, so they describe patterns, not your odds. The breakdown of classified Board denials shows the other common reasons.

What to leave out

Do not remove a record because it is unfavorable. Flag it and ask the clinician whether it changes the analysis. Do leave out duplicate exports, blank pages, unrelated sensitive records and hundreds of unindexed pages when a smaller relevant packet answers the question.

Build the packet from sources you can trace

Raven Nexus can use uploaded or Claim Workspace records, show selected source passages with dates and page references where available, and assemble an evidence appendix for clinician review. A free account includes one starter assessment; full drafting and further comparisons need Standard or Plus. Claim Raven sells the tool and has a commercial interest in it. The clinician still decides whether the packet is enough.

If you have not asked yet, read how to ask your doctor for a nexus letter before you send the packet.

Records for a nexus letter: common questions

Sources and scope

Checked September 23, 2026: VA evidence requirements (DD214, service treatment records and medical evidence); 38 C.F.R. § 3.310; Board decision A25017424 (February 26, 2025, denied), which applies only to its own record. The denial-reason split is Claim Raven's audited classification of denied condition records. The index above is fictional; which records matter depends on the condition and the question.