A VA claim is decided on the contents of a file. The rater does not know your history, your symptoms, or your service beyond what the documents show. That is why two veterans with the same condition can receive very different decisions: one file explains the story, the other leaves the rater to guess.
Service treatment records
Service treatment records document what happened in uniform: sick-call visits, injuries, exam findings, separation physicals. They establish the in-service element. Their absence is not fatal - many conditions were never reported at the time - but it does raise the value of other evidence.
VA and private treatment records
These show the current diagnosis, the treatment history, and how the condition has behaved over time. Continuity of treatment matters for rating severity as much as for service connection. Our records guide lists the documents worth gathering, including the VA Blue Button report.
Diagnostic testing
Sleep studies, imaging, audiograms, pulmonary function tests, and lab results convert symptoms into findings a rating schedule can be applied to. Many rating criteria are written directly around test values - see sleep apnea ratings and hypertension ratings for examples.
Where veterans start
Every case is different, and there is no obligation at any step. When veterans want to understand what their records actually support, these are the two most common starting points:
- Medical records review
A licensed physician reviews your records for a $250 flat fee and identifies which conditions the available evidence may support. The fee is refunded in full if nothing supportable is identified.
- Nexus letter
When the records support one, a licensed provider writes the medical opinion that addresses the link between your condition and your service or an already service-connected disability.
Lay evidence
Veterans and the people around them can testify to what they observed. Under 38 CFR 3.159, lay evidence is competent to establish symptoms a layperson can perceive, such as snoring, pain, or ringing in the ears. A personal statement and buddy statements fill gaps that records cannot.
Medical opinions
The opinion is the piece that ties the rest together. A Compensation and Pension examiner may provide one; when that opinion is negative or absent, an independent opinion from a qualified clinician puts reasoned medical analysis into the file. What is a VA nexus letter describes what a usable opinion contains, and the C&P exam compared with an independent nexus letter explains how the two differ.
Why files come up short
- No clinician ever addressed the relationship between the condition and service
- Treatment history is scattered across providers and never collected in one place
- Testing that would document severity was never ordered
- Symptoms were described in conversation but never written down anywhere
If you are not sure which of these applies to you, a medical records review reads the file the way a rater would and tells you what is present and what is missing. If the answer already came back as a denial, what "no nexus" means helps you read the letter. You can also speak with our team by phone at no cost.