The "As Likely As Not" Standard: What It Really Means for Your VA Claim

5-11-2025

By Dr. Howard Friedman MD | Veteran | U.S. Army Medical Corps | Internal Medicine | HHOM LLC

A balancing scale and question mark reflect the VA’s ‘at least as likely as not’ standard—where benefit of the doubt tips the scale in the veteran’s favor.

The U.S. legal system sets different standards of proof depending on the case. In a criminal trial, guilt must be proven beyond a reasonable doubt. In civil court, it’s typically a preponderance of the evidence—just over 50%.

But the VA operates under its own standard. Veterans' claims are meant to be handled in a non-adversarial environment. That means the benefit of the doubt goes to the veteran. In VA terms, that standard is called “as likely as not”—a 50/50 balance. If the evidence for and against a service connection is equal, the tie goes to the veteran. The glass is half full.

So, what happens if the scales tip the other way?

During a Compensation & Pension (C&P) exam, VA clinicians may conclude that a condition is “less likely than not “connected to service. That’s a legal way of saying they believe there's less than a 50% chance your condition is related to military service. And if that conclusion stands uncontested, your claim may be denied.

But here’s where you can shift the scale: through a Nexus Letter.

A Nexus Letter is a medical document that connects your current condition to your time in service. Nexus literally means connection. But it’s not just about stating an opinion—it must be crafted by a physician who:

• Understands VA standards

• Maintains impartiality

• Has the clinical credentials and experience to carry weight

• 
  

That’s where I come in.

As a board-certified internal medicine physician, a U.S. Army veteran, and a former VA medical manager with nearly two decades of experience inside the system, I know how to write Nexus Letters that meet the “as likely as not” standard—and stand up to scrutiny.

Let’s break it down. Every VA disability claim involves three critical questions:

1. Are you eligible? Did you serve? Was your discharge honorable?

2. Do you have a diagnosable condition? And how severe is it?

3. Is it service-connected? Did your condition result from—or get worsened by—your time in service?

   
   

It’s that third question where most claims live or die. And it’s exactly where a well-reasoned, evidence-based Nexus Letter can tip the balance in your favor.

If you've been denied, if your C&P exam came back with a “less likely than not” conclusion, or if you're preparing to file your first claim and want to do it right—this is the time to act.

You don’t need to walk this road alone.

Ask Dr. Howard. Visit HHOMLLC.com to submit your question or learn how I can help with a Nexus Letter tailored to your case.

I’m here—because your story matters. And you deserve to be heard.

—Dr. Howard Friedman MD

Board-Certified | Internal Medicine | Veteran | U.S. Army Medical Corps

Founder of Howard’s House of Medicine (HHOM LLC)

https://www.hhomllc.com

Q: What if my C&P exam said my condition is “less likely than not” connected to my service?

A: This means the VA examiner concluded there’s less than a 50% chance your condition is service-connected. While discouraging, this isn’t the final word. A properly written Nexus Letter from a qualified physician can challenge that opinion. If the medical evidence you submit brings the scale back to 50/50, the VA must rule in your favor under the “as likely as not” standard.

Q: How does the VA’s “as likely as not” standard differ from other legal standards?

Q: Can a Nexus Letter really make a difference in my VA claim?