Writing a Nexus Letter: The Bridge Between Service and Compensation

4-20-2025

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

Dr. Howard Friedman, MD, a veteran and former VA physician, carefully drafting a Nexus letter to support a veteran’s disability claim. His expertise bridges the gap between service and compensation.

A claim begins with silent weight,

A journey shaped by form and fate.

But proof alone won’t tip the scale,

Without a voice to tell the tale.

So let the record rise and stand—

With truth in mind and expert hand.

---Dr. Howard Friedman MD

The VA disability process begins with the filing of a claim. This initiates the evidence-gathering phase, during which a veteran may undergo a Compensation and Pension (C&P) examination and submit supporting documents such as a Disability Benefits Questionnaire (DBQ). Once all evidence is gathered, the VA reviews the claim and issues a decision. This decision addresses three core elements: whether the condition is service connected, what disability rating is assigned, and the effective date of the benefit. The veteran is then notified by mail. If the claim is granted, the veteran begins receiving monthly compensation, along with any retroactive back pay owed. However, if the veteran disagrees with the outcome—perhaps the condition was not service-connected, the rating was too low, or the effective date was inaccurate—they have the right to appeal.

That’s where the Nexus Letter becomes essential. A Nexus Letter is a powerful piece of medical evidence used to support a VA disability appeal. It provides a clearly written, professional medical opinion that connects a veteran’s current diagnosis to their military service. The term “nexus” simply means a connection. This letter serves to explain how and why a veteran’s medical condition is at least as likely as not (a 50% probability or greater) related to events, exposures, or injuries sustained during their time in the military. Without this link, even a clearly diagnosed condition may be denied service connection.

Crafting a strong Nexus Letter requires far more than opinion—it demands clinical expertise, sound reasoning, and citation of relevant medical research. A credible letter lays out the veteran’s medical history, service records, and symptom timeline. It must be written by a qualified healthcare professional who not only understands the VA system but can also interpret complex medical data and draw logical, evidence-based conclusions. The strength of the Nexus Letter hinges on the physician’s credentials, the rationale provided, and the clear articulation of the connection between service and current disability.

At HHOM LLC, our Nexus Letters are authored by Dr. Howard Friedman, a board-certified Internal Medicine physician with more than 30 years of medical experience. Dr. Friedman is also a veteran who served in military medical operations and spent 19 years as a VA physician. His leadership roles at the VA included serving as a first-line supervisor, directing a pain management clinic, and acting as the Attending Physician for a home-based primary care program. This blend of military service, VA experience, and medical acumen gives our letters unmatched authority and authenticity.

When you work with HHOM LLC, you receive more than just a document—you receive a voice that speaks on your behalf with clarity, conviction, and credibility. We understand the nuances of VA disability claims and the high stakes involved. Our goal is simple: to write Nexus Letters that get results. We stand behind our veterans because we’ve stood in their boots.

—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

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Frequently Asked Questions:

Question: What is a Nexus Letter, and why is it important for VA claims?

Answer: A Nexus Letter is a medical opinion that links a veteran’s current condition to their military service. It’s often the deciding factor in whether a claim is approved, especially when the connection isn’t clearly documented in service records.

Question: What makes a strong Nexus Letter credible in the eyes of the VA?

Answer: A credible Nexus Letter is written by a qualified physician, uses clinical reasoning, references the veteran’s history, and cites relevant medical literature. The letter must clearly state that the condition is “at least as likely as not” connected to service.

Question: How does HHOM LLC ensure high-quality Nexus Letters?

Answer: At HHOM LLC, Dr. Howard Friedman—a board-certified internist, veteran, and former VA physician—personally writes every Nexus Letter. His deep experience inside the VA system and decades of clinical work ensure that each letter is thorough, authoritative, and tailored to VA expectations.