If the VA Concedes Asbestos Exposure, Why Do I Still Need a Medical Nexus?

Military veterans with mesothelioma are often confused – and understandably frustrated – when the U.S. Department of Veterans Affairs (VA) says it concedes asbestos exposure but still asks for more evidence before granting service-connection for the cancer.

The confusion usually comes from a misunderstanding of what “conceded exposure” actually means and what a medical nexus really is.

So let’s dive in and try to make sense of it all.

Three Things the VA Must See to Grant Service Connection

For any VA Disability Compensation claim, the VA must be satisfied that all three of the following are true:

1. You have a diagnosed medical condition. For the purposes of this blog, I will often use “mesothelioma” as an example. Mesothelioma is a rare type of cancer caused solely by exposure to asbestos. It’s a good example of how and when the nexus letters come into play during the VA claims process.
2. There was an event during your military service where you were exposed to something, injured, or became ill. For the purposes of this blog, I will use asbestos as the example of the dangerous substance you were exposed to during service.
3. There is a medical link (called a “nexus”) between the two.

Here is what you really need to understand about these requirements when it comes to asbestos disease claims, such as VA Disability Compensation claims for mesothelioma. Just because the VA concedes that you were exposed to asbestos in the military, does not mean:

• That your military exposure is the primary reason you developed mesothelioma (or another asbestos-related disease such as asbestosis)
• That the VA has conceded that your claimed disease is even asbestos related

What Is a Medical Nexus (in Plain English)?

A medical nexus for an asbestos disease is simply a doctor saying, “This disease was caused by, or is ‘at least as likely as not’ to have been caused by, asbestos exposure.”

That’s it.

But here is where most veterans get tripped up: A medical nexus does not always have to come from your doctor.

When A Medical Nexus for VA Claims Does Not Need to Come From Your Doctor

Some diseases are so strongly associated with asbestos exposure that the VA already accepts them as “asbestos diseases.” When a veteran has one of these “asbestos” diseases, they do not need a medical nexus statement from their doctor.

Diseases the VA Knows Are Caused by Asbestos

The diseases the VA knows are “asbestos diseases” include:

• Pleural mesothelioma
• Peritoneal mesothelioma
• Asbestosis (asbestos-related lung tissue scarring)
• Pleural plaques (thickening/calcification of the lung lining; often a symptom of or precursor to pleural mesothelioma)

For these conditions, the VA does not require you to obtain a written nexus letter from your oncologist or pulmonologist.

However – and this is critical – a medical nexus is still required. The difference is who provides it.

Who Provides the Medical Nexus in Cases of Mesothelioma and Other Asbestos Diseases?

VA rating officers are not doctors. They cannot make medical judgments on their own. For instance, they don’t have the ability to distinguish between malignant forms of mesothelioma – which are asbestos related – and non-malignant forms of mesothelioma which are not. So what does the VA do?

In most asbestos disease claims, the VA:

• Sends your medical records to a VA doctor or contracted C&P examiner
• Asks that doctor to:
  • Confirm you truly have the claimed disease (via a biopsy for cancer cases)
  • Confirm that the disease is an asbestos-related condition

Because diseases like malignant pleural mesothelioma and peritoneal mesothelioma are medically understood to only be caused by asbestos, the VA doctor should confirm the nexus.

In other words:

• The nexus exists.
• The VA doctor confirms it.
• Your own doctor does not need to write a medical nexus statement.

Why the VA Still Cares About Your Civilian Work History for Asbestos Diseases

Here’s the part many veterans don’t expect. Even when the VA accepts that your disease (such as mesothelioma) is caused by asbestos, the VA still must decide: “Was the asbestos exposure during military service at least as significant as the asbestos exposure in the veteran’s civilian jobs?”

This is required by VA law. This impacts whether the veteran with mesothelioma should apply for VA Disability Compensation (exposure primarily from military service) or VA Pension (exposure primarily from civilian jobs). And for cancer, VA Disability Compensation always pays more per month than VA Pension.

So you must still show both of the following:

• You were exposed to asbestos in service.
• Your military exposure was equal to or greater than your civilian occupational exposure before and after service.

If you worked in shipyards, construction, manufacturing, insulation, or similar jobs before or after your military service, the VA will examine that very closely and attempt to compare those exposures to your military exposures. Those jobs all had high rates of asbestos exposure during the 20th century.

This is why you need to provide a “military nexus” between your asbestos disease and the military, in the form of an asbestos exposure summary letter.

How the VA Gets Civilian Asbestos Exposure Information

If you provide a clear exposure history with your VA Disability Compensation claim, the VA can often decide the case based on that and your records alone.

If you do not, the VA may do one or more of the following:

• Send you written questions about your exposure history
• Ask a VA doctor to call you for an interview
• Schedule a C&P exam focused on exposure history, not physical testing

This is standard for asbestos claims and does not mean something is wrong with your case.

When a Medical Nexus Letter Does Need to Come From Your Doctor

Things change when the claimed condition has multiple possible causes, such as:

• Lung cancer
• GI tract cancers
• Interstitial lung disease
• Idiopathic (of unknown origin) pulmonary fibrosis
• Other respiratory or gastrointestinal conditions

In these cases, asbestos is one possible cause, but not the only one. Lung cancer and other diseases can be genetic, caused by smoking cigarettes, and exposure to ionizing radiation, radon gas, etc.

Here, the VA cannot automatically concede the nexus. The VA will not simply send your case to a VA doctor to confirm the presence of an asbestos disease. There is no understood nexus between asbestos exposure you may have experienced during military service and your condition.

This is when a medical nexus statement from your own doctor becomes critical.

What the Doctor Must Say in the Nexus Statement (and Why the Wording Matters)

For VA purposes, the doctor must state that your disease is “at least as likely as not” to have been caused by asbestos exposure.

That phrase has a specific meaning. It means:

• At least a 50% probability of the disease being caused by asbestos exposure
• Not speculation
• Not “possibly”
• Not “could be related”

Note: Even stronger wording, such as “more likely than not” – meaning more than a 50% probability – is even better. This means, for example, asbestos exposure is far more likely than genetics or smoking tobacco to cause your lung cancer.

Your doctor’s opinion must be strong enough to convince the VA doctor reviewing the claim, not just the rating officer. However, this is highly likely as your doctor is a specialist in your specific disease, whereas the VA doctor reviewing your medical records is usually not an expert in the same field. This means that the VA doctor is likely to defer to the expert judgement of your own doctor.

The Bottom Line

• Conceded exposure to asbestos does not equal automatic approval of an asbestos-related VA Disability Compensation claim.
• A medical nexus is always required.
• For true asbestos diseases, such as mesothelioma, the VA’s doctor usually provides the medical nexus.
• You still must show your military exposure was at least as significant as your exposure in your civilian jobs.
• For diseases with multiple causes, your doctor’s medical nexus opinion is essential.

Understanding this distinction can prevent unnecessary delays, denials, and frustration.

Clarification: Many of you reading this blog may be familiar with nexus statements because your Veteran Service Officer (VSO) or claims agent asked you to get one from your doctor in the past. Most of the time, your doctor is being asked to link your disability directly to the military (such as a back injury, or a knee problem).

This is different from a medical nexus statement. Claims for diseases due to exposures to dangerous substances in the military – such as asbestos – usually require a medical nexus and a military nexus.

The medical nexus comes from a doctor, whereas the link to the military (an exposure summary nexus letter) comes from you, the veteran, as you know best what you were exposed to in the military, whereas your current doctor only knows what you have told him/her about your exposures.

Therefore, an exposure summary nexus letter from your doctor isn’t going to carry much weight with the VA because the VA knows that your doctor only knows about your exposures based on what you have told them. Not from any first hand knowledge. Better for that information to come directly from you. If you do want to get a military nexus letter from another person, it’s better to get a “buddy statement” from someone you served with who can attest to the exposures you suffered while in the military.

If you are unsure which category your condition falls into, getting guidance early can make the difference between a smooth claim and a prolonged appeal.

For questions about nexus requirements, contact me, Mesothelioma Guide’s VA-accredited claims agent, retired LCDR Carl Jewett, at (844) 838-6376 or cjewett@mesotheliomaguide.com.