Elite Medical Review Associates, LLC

Elite Medical Review Associates, LLC is the nation’s premiere veteran-focused medical consulting firm.

Our trained medical professionals prepare VA nexus letters for U.S. veterans seeking VA compensation and successful VA decision appeals.

With offices in Florida, our medical staff specializes in forming medical nexus opinions for veterans’ VA disability claims and courtroom litigation. Renowned for achieving service connection in some of the nation’s most complex VA claims cases, our medical experts have decades of experience advocating for veterans with all types of health conditions.

What is a Nexus Letter?

A nexus letter is a document drafted by a doctor or other medical professional. It is a tool that can be used to support your VA disability claim by providing a link between your health condition and the time you spent in the military. These documents should cover three major points: the nature of your diagnosis, an in-service stressor, and a connection between the two. 

A Current Diagnosis

The cornerstone of any VA claim is a disabling injury or illness. This is a condition that impacts your quality of life and makes it impossible for you to maintain meaningful employment. There are countless health issues that might qualify, including physical injuries to your head, hands, feet, or spine. Illnesses are especially common as well, particularly those linked to toxic exposure. Your diagnosis must be current, meaning that your doctor has determined you are still living with the condition. 

An In-Service Event

The letter should also provide details of an in-service event or stressor. The particular event will depend on the nature of your disability. It could be a combat wound or a motor vehicle accident that resulted in your physical injury. It might also be long-time exposure to burn pits or contaminated drinking water. The details of these events are often reflected in your service records. 

A Nexus Between the Two

The primary purpose of the nexus letter is to highlight a link between the first two elements. This is done by a doctor or other medical professional who reviews your condition, researches potential causes, and links them to the service-related incident or stressor in your past. The letter should also include a final conclusion that your disability likely occurred as a result of this in-service event. 

Types of Cases

Disability benefits through the VA cover the full spectrum of physical and psychological injuries that can stem from your military service. We can help you obtain a nexus letter for the following conditions:

Why Do U.S. Veterans Choose Elite Medical Review Associates?

As a trained physician, U.S. attorney, and American Academy of Legal Medicine Fellow, our chief medical analyst offers decades of experience advocating for U.S. veterans in highly-complex VA disability claims. Our medical director is a medical doctor who also holds a Ph.D.

Many of our veteran-focused team members hold dual degrees in medicine and law, offering unparalleled insight and resources for clinical, scientific, and legal evidence supporting veterans claims – insight and resources that medical professionals alone lack.

We recruit our case managers from law firms specializing in  Social Security claims, VA disability claims, medical malpractice cases, and personal injury cases – ensuring an in-depth understanding of law as it applies to medicine.

Consistently on the cutting edge of medical-legal developments, our medical professionals aren’t preoccupied with developing a practice and generating revenue. As specialists in forensic medicine, our experts are handpicked for their writing and analytical abilities and their knowledge of the VA claims process and nexus letter requirements, including VA-required standards of proof and legal language requirements – increasing the odds of service connection.

Our physicians maintain strong connections with the nation’s top veteran’s disability attorneys, offering high-quality legal advocates for veterans pursuing more difficult disability claims and appeals. In many cases, these legal advocates will front the cost of our nexus letters and medical consulting services, so veterans don’t have to worry about paying fees until they after they collect their VA compensation.

Our physicians provide an honest, objective assessment of your case before you decide to use our nexus letter services, advising you on the best route for your case that will result in the least cost to you.

Over the years, we have honed our services to be able to provide high-quality medical nexus letters at a reasonable, fixed, predetermined cost. Our extensive experience with veterans’ claims allows us to direct you to the medical experts that fit best with your specific case, increasing your chances of winning VA compensation.

Many medical consulting firms attempt to be a “Jack of all trades,” going well beyond the scope of their expertise, training, education and even licensure – resulting in veterans receiving fragmented, incomplete, unqualified nexus letters and access letter reviews.

For example, it is common among inexperienced or unqualified firms to assign a psychologist to write a medical opinion linking a veteran’s sleep apnea to military service. Sleep apnea is clearly a condition requiring extensive training in sleep medicine and pulmonary function. Not only did this psychologist go beyond the scope of his training and expertise, but he went beyond the scope of his licensure. Needless to say, the VA denied the veteran’s VA claim for sleep apnea service connection.

At Elite Medical Review Associates, our doctors are renowned for their meticulous research, recognition of all relevant links between service events and disabilities, and diligent nexus letter preparation. By providing strong support for VA claims right from the start, we help our veteran clients avoid months to years of VA appeals for denied claims - preserving valuable time and money.

Veterans seeking service connection and maximum disability ratings need the benefit of a medical consulting firm whose in-house experts can guide you to VA-qualified medical professionals in various specialties that will advocate on your behalf.

U.S. Medical Experts Specializing in VA Nexus Letters

High-quality nexus letters may be less critical for conditions on VA presumptive lists. However, the majority of VA claims involve non-presumptive conditions. In these cases, the nexus letter can mean the difference between winning VA compensation and years of VA denials or claims appeals.

What to do if your claim has been denied?

With the VA denying more than 30 percent of all veterans disability claims, it is important to understand why. It is often possible to overturn these denials on appeal. Some denials occur for the following reasons:

Misunderstanding or Misreading the Medical Nexus Opinion

Claims adjudicators working for the VA are humans, and humans make mistakes. In some cases, claims are denied for no other reason than the person making the decision did not understand the supporting documentation in front of them. 

This can be an issue in cases where the VA nexus letter is unclear, lacks an obvious conclusion, uses speculative language, misunderstands the standard of proof, or does not provide the supporting evidence needed to establish a service connection. Supplementing with additional medical expert reports, including your medical records, might be enough to get a better outcome.

Unfortunately, these denials also frequently occur as the result of carelessness on the part of the VA adjudicator. The VA might also fail to adequately train its staff to understand the complex issues that go into determining a service connection. The good news is that these issues are frequently resolved on appeal. 

Doctor Writing the VA Nexus Letter Does Not Meet VA Requirements

Another issue that might lead to a denied claim is the lack of proper credentials on the part of the doctor who wrote your VA nexus letter. That said, the qualifications are fairly limited. Any doctor–including an M.D., a D.O., or any specialist, qualifies so long as they have the requisite training and experience. A Ph.D. also suffices depending on the speciality. In addition, VA will accept medical reports by physician’s assistants and nurse practitioners. In fact, VA often uses nurse practitioners to conduct its C&P exams. However, the relative strength and weight of the medical opinion is affected by the credentials of the person writing the report. For instance, a nurse practitioner’s report will carry less weight than an M.D.’s report–even though the nurse practitioner is considered competent to render opinions.

Denials may be more common when it comes to healthcare professionals who are not doctors. The VA will accept letters from some of these individuals but not others. For example, they are open to receiving a letter from a physician assistant or a nurse practitioner, given the extent of their medical training. A psychologist may also author a letter for mental health issues so long as they hold a Ph.D. A professional with a Ph.D in toxicology is also accepted. Some of the professionals that are not recognized may include acupuncturists, herbalists, and new age healers. Although there are varying points of view on the use of chiropractors, we have seen success with chiropractors’ reports so long as they confine their review and analysis to the issues involving the spine.

Doctor Fails to Provide Enough Evidence to Support Service Connection

Having a nexus letter is not enough to guarantee the VA will approve a claim and grant benefits. The content of the letter is crucial if your claim is to be successful. In some cases, the VA will deny benefits when the doctor that authors your letter fails to provide evidence that supports their conclusion that your condition is service-connected. In other words, the nexus letter must contain a detailed rationale that explains the basis for the decision.

There is a misconception that these letters only need to reach a final conclusion from a doctor that your disability is related to your military service. In reality, the conclusion that the doctor comes to must be supported by reference to the evidence, scientific literature, and contain sound reasoning. This is referred to as the rationale for the opinion. Without a rationale, the report is considered conclusory or what is called a “net opinion” and it will carry little weight with the VA. The letter should highlight aspects of your service that are likely to have contributed to the condition you are living with. 

In some situations, these denials will be due to the lack of research or scholarly journals included. Many successful letters build their conclusion on relevant research that links certain factors to a disability and then explain how that is relevant to your case. 

Doctor Uses Incorrect Standard of Proof in Medical Nexus Opinion

In some situations, a doctor who uses the wrong standard of proof could render their opinion unreliable to the VA. There are two general standards to be aware of, “at least as likely” and “more likely than not.” In order to qualify for disability benefits, your letter should conclude that it is at least as likely than not that your condition is service-connected. However, using the higher burden that it is more likely than not can be a red flag for the VA, especially when the evidence does not support this conclusion. Inexperienced doctors may often use speculative language like “it is possible” or “may be” and this will result in their report being rejected.

Doctor Uses Unclear, Inconclusive Language in Medical Nexus Opinion 

There are few things more important than clarity when it comes to the language of a VA nexus letter. Having the support of a medical expert who understands your condition is valuable, but only to the degree that they are able to communicate that your issues were caused by your time in the military. 

Unclear language can lead the VA to the wrong conclusion. In fact, it might also make it impossible for the VA to form a clear picture of your disability and its causes. Any type of confusion could result in a denial. 

A significant problem that can arise with these letters is the lack of an appropriate conclusion. It is not enough for the doctor writing on your behalf to describe your condition or provide research that implies a link to your service. If your letter does not have a strong conclusion that your condition is at least as likely as not service-connected, the VA is likely to deny your claim. The conclusion is the first thing the adjuster is going to read, and not having one to support your claim could be detrimental. 

Non-Supportive C&P Exam Report

Although the VA has a duty to help you with your disability benefits claim, their efforts can do more harm than good in some cases. It is common for the VA to request that you submit to a C&P exam as part of the claims process. This exam is often relatively informal, involving little more than answering questions that are entered into the VA system. 

The problem is that these examinations often come with a conclusion regarding your disability and its links to your military service. The claims decision-maker working for the VA might decide to deny your claim based on the conclusions of the C&P exam, even if your nexus letter found a service connection. If your original claim lacked a letter, this documentation could be enough to secure a more favorable result in your case on appeal.