Letters That Speak-The Art and Responsibility Behind a Nexus Letter
- Dr. Howard A. Friedman MD, founder of HHOM LLC
- Jul 28
- 4 min read
7-12-2025
By Dr. Howard Friedman MD | Veteran | U.S. Army Medical Corps | Internal Medicine | HHOM LLC
They come not as pages, but as bridges wide,
Between the wounds we carry and truths denied.
Not just ink, but honor—each word must weigh,
A path from silence to what vets dare say.
Through facts and faith, these letters arise—
A veteran’s voice where justice lies.
---Dr. Howard Friedman M.D.
Introduction: What a Nexus Letter Truly Means
The word nexus stems from the Latin nectere, meaning to bind or tie. It’s the origin of connect and annex—and in the context of VA disability, it refers to the essential connection between a veteran’s current condition and their time in service. But a Nexus Letter is more than a connection. It’s a bond—between physician and veteran, between service and sacrifice, between lived experience and documented evidence. This blog explores what makes a Nexus Letter meaningful, impactful, and ultimately effective. Anyone can write a letter—but this is more than that. It’s a formal, evidence-based opinion that carries legal, ethical, and emotional weight. Tone and precision matter just as much as content.
The Weight of the Role
Writing a Nexus Letter is not a formality—it’s a responsibility. These letters are often the only bridge between denial and approval, between being heard and being dismissed. Veterans entrust me with their stories, their records, and their futures. There is no template. No shortcuts. A good letter is built through deep listening, clinical judgment, and ethical clarity. I must first be convinced of the connection myself before I advocate for it on paper.
Listening Before Writing
Before typing a word, I listen. That’s the foundation of medicine—especially here. What does the veteran want? What is their story? What have they endured—not just in their medical records, but in real life? Records matter. But so does lived experience. My job is to combine both. Curiosity, compassion, and clarity guide the process.
Connecting Medical Evidence to Military Service
The standard the VA uses is “at least as likely as not”—meaning a 50% or greater chance the condition is service-connected. That phrase must be used. But so must clinical reasoning, credible references, and clear structure.
Each letter I write includes:
My medical background and why I’m qualified to opine on the condition.
A review of all submitted medical and service records.
A summary of my evaluation or conversation with the veteran.
A detailed argument that explains the connection.
A conclusion that states my professional opinion, usually using “at least as likely as not.”
My signature and credentials, attesting to the letter’s contents.
Integrity Over Outcome
I don’t write what I don’t believe. If I don’t see a connection, I will say so—gently, clearly, and honestly. That’s integrity. That’s what veterans deserve. I’ve long believed that inflammation is the common denominator behind most diseases—and military life is, by nature, inflammatory. Connecting that insight to a veteran’s specific diagnosis is often the key.
Why I Write These Letters
I served. I understand the cost. That’s why I do this. I don’t outsource. I don’t use templates. I don’t cut corners. Every letter is written by me, for one person at a time—with care, precision, and heart. This is how I continue to serve. With my pen, with my training, and with my deep belief in justice and healing.
Closing Thoughts
A good Nexus Letter gives voice to what’s often been dismissed. It can open doors. Restore dignity. Bring long-overdue recognition. These letters don’t guarantee approval—but they do insure the veteran is finally heard.
Thank you for reading.
Final Reflection Poem
With your commitment to serve, we’re honored to stand,
A Nexus Letter, written by careful hand.
We hear. We listen. We study. We write—
Your truth, your fight, brought into light.
At Howard’s House of Medicine, your case is our cause—One letter, one voice—upholding the laws.
—Dr. Howard Friedman MD
Board-Certified | Internal Medicine | Veteran | U.S. Army Medical Corps
Founder of Howard’s House of Medicine (HHOM LLC)
Frequently Asked Questions:
Q: What is a Nexus Letter, and why does it matter in a VA claim?
A: A Nexus Letter is a medical document written by a qualified physician that connects a veteran’s current medical condition to their military service. It can be the deciding factor between an approved or denied claim—especially when the VA needs more than just medical records to establish service connection.
Q: Who should write a Nexus Letter?
A: Ideally, a Nexus Letter should be written by a physician who understands VA standards, legal precedent, and how to document opinions "to a reasonable degree of medical certainty.” Veterans benefit most when their letters come from providers with clinical experience, military familiarity, and the ability to articulate both the medical and functional impact clearly.
Q: Does the VA always accept Nexus Letters?
A: No, not automatically. The VA evaluates the credibility and rationale of each letter. A strong Nexus Letter includes thorough record review, a well-supported medical opinion, and clear language explaining the link between service and condition. Cookie-cutter or vague letters often get ignored. A well-reasoned, customized letter stands out.
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