A VA decision letter is longer than it needs to be, and the part that matters is easy to skim past. The 'Reasons and Bases' or 'Evidence' section states, usually in one or two sentences, which element the rater found unestablished. Everything else is boilerplate. Our guide to the gaps behind most denials explains what each of those findings means.
What to look for
- The exact list of evidence the rater says was reviewed - note anything you submitted that is missing from it
- Whether a C&P examination was performed, and what the examiner concluded
- The specific sentence naming the unestablished element
- The effective date assigned to any granted condition
- The deadline for a Supplemental Claim, Higher-Level Review, or Board appeal
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.
Then choose the lane
New evidence - including a nexus opinion - belongs in a Supplemental Claim. A Higher-Level Review is for a decision you believe was wrong on the evidence already of record and does not accept new evidence. Filing new evidence in the wrong lane wastes months. Free, accredited help is available for either path - here is how to find and work with a VSO. If new medical evidence is what the record needs, a paid medical records review is the place to start.
Frequently asked questions
What is a VA nexus letter in simple terms?
It is a written medical opinion from a qualified provider stating that a current diagnosed condition is connected to your military service, with the reasoning explained. It supplies the medical-link element of a service-connection claim.
Does the VA require a nexus letter?
No. The VA does not require one, and no single document guarantees a grant. A nexus letter matters most when the record contains a diagnosis and an in-service event but nothing medically connecting the two.
Can I file a claim without a nexus letter?
Yes. Many claims are granted on service treatment records, presumptions, or a favorable C&P examination alone. A nexus opinion is one form of evidence, used when the record has a gap it can close.