If you’re a veteran filing or appealing a VA disability claim, you’ve probably heard about the importance of a nexus letter — a medical opinion that connects your current condition to your military service. But a common (and critical) question is:

Who can actually write a nexus letter — and who should you trust to do it right?

This article breaks down:

• ✅ Who’s allowed to write a nexus letter
• 🔎 What to look for in a quality provider
• 🛑 Red flags to avoid
• 🧭 Where to find one you can count on

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✅ Who Can Write a Nexus Letter?

According to 38 CFR 3.159, “Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It would also include statements contained in authoritative writings such as medical and scientific articles and research reports or analyses.”

This essentially means the VA considers “competent medical evidence” as evidence provided by a medical professional who has the appropriate medical education and training. This doesn’t mean all providers are equally helpful. Here is who I think qualifies.

1. Medical Doctors (MDs or DOs)

These are the gold standard. Physicians — especially in specialties related to your condition — are the most respected sources of medical opinions by the VA.

Best for: Physical health issues, secondary conditions, sleep apnea, migraines, etc.

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2. Clinical Psychologists (PhD or PsyD)

For mental health claims like PTSD, depression, anxiety, or TBI-related cognitive issues, licensed psychologists are required for mental health claims.

Best for: PTSD, depression, anxiety, TBI-related symptoms

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3. Physician Assistants (PAs) & Nurse Practitioners (NPs)

While not always given the same weight as doctors, many PAs and NPs can write competent nexus letters, especially when they work alongside MDs or are familiar with VA claims process. It should also be noted that many C&P examiners are PAs and NPs (at least in my experience).

Best for: Supporting evidence when they have a proven track record

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4. Specialists

The more relevant the provider’s specialty is to your condition, the stronger the letter. For example:

• A cardiologist for a heart condition
• A neurologist for migraines or seizures
• An orthopedic surgeon for back or joint problems
• An ENT for hearing loss, sinusitis, rhinitis

These letters carry more weight when appealing or filing complex claims.

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🔍 What Makes a Good Nexus Letter?

The VA doesn’t just want a doctor to say “yes, it’s related.” They want detailed medical reasoning. A quality nexus letter should include:

✅ The doctor’s credentials and contact info
✅ A review of your medical and service history
✅ A clear diagnosis (if not already in your file)
✅ A “more likely than not” opinion (or “at least as likely as not”)
✅ An explanation of the medical link between your service and your condition
✅ Citations to medical literature or known military exposures (if relevant)
✅ Signature and date

💬 Pro Tip: The phrase “at least as likely as not” is VA language that meets the VA’s burden of proof.

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🛑 Who Shouldn’t Write Your Nexus Letter?

Just because someone can write a letter doesn’t mean they should. Avoid:

🚫 Doctors who say, “I don’t do VA claims” or “That’s outside my expertise.”
🚫 Providers unfamiliar with how the VA evaluates service connection.
🚫 Letters that lack explanation and just say, “It’s related.”
🚫 Family members, friends and/or anyone without medical education and training

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🧭 How to Find the Right Doctor for a Nexus Letter

Finding the right doctor can be hard. Your VA doctor likely won’t write one. I highly suggest asking your private doctor to help you evaluate whether or not your condition is connected to service – either direct or secondary. I know asking a personal doctor can be difficult and many won’t want to get involved but I think it is a great first option!

If not, or you simply don’t feel comfortable asking your personal doctor you should consider seeking out a medical professional who writes nexus letters.

Independent Medical Opinions are a great option because it shows a third party review (especially if its in your favor). This is even better when both your personal doctor and a second independent medical professional make the same or close to the same opinion.

That’s why we created the Nexus Letter Directory — a free tool to help veterans search for medical professionals that I have found online and in various groups that claim to understand VA claims and offer:

• Independent medical opinions
• nexus letters
• DBQ completion (in some cases)

Disclaimer: It is very important that you do your own due diligence. Most medical professional in this space will charge you for a nexus letter or independent medical opinion. Informedveteran.com does not have any affiliations with these medical professionals. I do not get a commission nor am I paid for referrals. I do sometimes make contact with them to make sure their listing looks appropriate but outside of that there is no relationship. I try my best not to include any nexus letter mills in this directory but I can NOT guarantee. Please do your own due diligence!

Other options include:

• Suggestions from VSOs or attorneys
• Private clinics that specialize in VA disability support
• Telehealth providers offering nationwide services

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🧠 Final Thoughts

A nexus letter can be the single most important document in your entire VA disability claim — especially for:

• Secondary conditions
• Conditions diagnosed after service
• Claims that were previously denied

But the letter is only as strong as the professional who writes it.

🎯 Choose someone with VA knowledge, medical credibility, and attention to detail.

And if you don’t know where to start, we’ve made it easy for you.
👉 Visit our Nexus Letter Directory to look for medical professionals who offer these services. Keep in mind these medical professionals charge for their services so please do your own due diligence.

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