Nexus Letters Explained

A helpful nexus letter explains who the doctor is and why they are qualified to give the opinion. It shows that the doctor reviewed the veteran's records, including service history and medical records. It describes the diagnosis and the in-service asbestos exposure, and then gives a clear opinion using the level of certainty the VA recognizes, commonly phrased as at least as likely as not. Most importantly, it explains the reasoning, such as the known link between asbestos and mesothelioma and the long delay between exposure and illness. An opinion without an explanation carries much less weight.

The letter can come from a treating oncologist, pulmonologist or another physician who understands mesothelioma and asbestos-related disease. A doctor who knows your case well may be ideal, though some treating doctors are uncomfortable writing legal-style opinions. In that case, a physician who reviews records independently may be an option. Ask the doctor early, because letters take time to prepare, and provide an organized packet with your service history, exposure statement and key medical records. The easier you make the review, the more likely the letter will be thorough and specific.

Letters that use uncertain language, such as saying exposure may possibly have contributed, are often given little weight. Letters that ignore other possible exposures, or that do not mention reviewing the service records, can also be questioned. If you had civilian asbestos exposure too, the doctor should address it honestly, since the VA standard does not require military exposure to be the only source. A service officer can review a draft letter and point out gaps before it is submitted. A weak letter can usually be strengthened later, but getting it right the first time avoids delays.

1. 1

   Ask your treating oncologist or pulmonologist whether they will write a nexus opinion.

2. 2

   Give the doctor an organized packet of service records, exposure statement and medical records.

3. 3

   Make sure the letter states a clear opinion and explains the medical reasoning behind it.

4. 4

   Have your service officer review the letter before submitting it with your claim.