Independent medical opinions and nexus letters for VA disability claims

An independent medical opinion, often called a nexus letter, answers the medical question at the center of a service connection claim: whether a condition is at least as likely as not (a 50 percent or greater probability) related to service, or was caused or aggravated by a condition that is already service connected. That is the standard VA applies to direct service connection under 38 C.F.R. § 3.303 and secondary service connection under § 3.310, with reasonable doubt resolved in the veteran's favor under § 3.102.

VA considers competent medical evidence from qualified clinicians, including private medical opinions. The opinions that fail are the ones that state a conclusion without reasoning it, ignore conflicting evidence, or cite literature that does not fit the facts of the case.

Every opinion we prepare states its scope, addresses the medical question actually at issue, and cites the records that support it. Where the evidence conflicts, we say so and explain how the conflict resolves.

Not every case needs an examination. Many opinions can be completed from a thorough record review when the file contains current findings and objective support. Where it does not, we say that too.