“I don’t understand what this means.”
I’ve heard this a thousand times. In fact, if I had a nickel for every time a veteran or a family member said to me, “I just got this letter from the VA about my claim and I can’t make any sense out of it,” I’d be rich.
So my goal in this multi-part blog series is going to be to translate what the VA says into what they mean. Today’s topic is going to be about why you need a VA disability nexus statement or nexus letter.
What Are VA Disability Nexus Statements?
In order for a claimed disability to be service-connected, the VA says there must be three criteria met:
- A medical diagnosis from a doctor
- An event, injury or disease that occurred on active duty
- A nexus between them
This is where a VA disability nexus letter helps. According to Webster’s Dictionary, nexus means “connection” or “link.” When the VA uses the term nexus, what they mean is a causal link between your claimed disability and your military service. Sometimes you are able to provide the nexus yourself, but most of the time this requires your doctor to write a short letter to the VA explaining the link between your disability and your service.
Not all VA Disability Compensation claims require a nexus statement, though. Disabilities diagnosed while you were on active duty do not require a nexus to your military service. They are simply conceded to be service-related if they manifest while you are serving (or within one year of leaving the service). Therefore, if you are diagnosed with a condition – let’s say, type 2 diabetes while you are still on active duty, then it will simply be approved as service-connected by the VA when you file your VA disability claim during your week of TAP (Transition Assistance Program) class before your EAOS.
Key takeaway for you or a loved one: Disabilities or diseases that manifest on active duty are automatically approved as service-related and don’t require a VA nexus statement.
Why to File a Disability Claim Even if Your Condition Isn’t Disabling
What if your diagnosed condition isn’t disabling when you get out? The answer is that you should still file a disability claim for it upon leaving the service. If it was diagnosed during active duty, but not disabling when you are discharged, the VA will most likely assign you a 0% rating.
This means they are service-connecting you for that disability, but not paying you any disability compensation (yet) because it isn’t disabling enough to warrant giving you any money. Which means that if it gets worse or flares up in the future (like an old knee injury might) then getting your rating increased is fairly easy since the condition is already service-connected.
All you need to do in this case is provide medical evidence that the condition has worsened, and as long as its severity is sufficient to receive a 10% disability rating or higher, the VA will start paying you the corresponding amount of disability compensation.
Key takeaway for you or a loved one: Before your End of Active Service (EAOS), always file a disability claim for any condition you have suffered while you were on active duty, even if they’re not disabling when you get out.
When You Need to Have a VA Nexus Letter
Now let’s switch gears and talk about when a nexus letter is needed to support your VA claim. Let’s say you have been diagnosed with lung cancer years after your service ended, and because you were exposed to asbestos on active duty, you want to file a VA Disability Compensation claim for it. In a case like this, you’re going to need two nexus letters. One from your doctor (preferably your oncologist) and another from you.
Your doctor will need to make the connection between your type of cancer and the likelihood that it was caused by asbestos. Since asbestos is a cause of lung cancer, this isn’t a hard connection to make medically.
Assuming your doctor’s letter convinces the VA that they should consider your lung cancer an asbestos disease, you will then need to make the connection between your asbestos lung cancer and your military service. Since your doctor established the link between asbestos exposure and lung cancer, there’s only one more link to make.
Asbestos was used a lot by the military – to build ships, aircraft, barracks, vehicles and more. If you served in the military, there’s a good chance you were exposed to asbestos at some point. If you served overseas, in the Navy or during a war, the odds increase. So, similarly, this link is not a difficult one to make.
I’ve seen some Veterans Service Officers tell the veteran to have their doctor make that connection. While it doesn’t hurt to have your doctor also state that he/she believes your asbestos lung cancer was caused by your asbestos exposure in the military, the VA knows that everything your doctor knows about your exposure history came from you. So it’s repetitive. And frankly, your doctor is surely going to provide far fewer details about your exposures to asbestos than you can provide yourself.
So I never tell veterans with an asbestos disease to get their doctor to link their asbestos disease to the military. Instead, I help veterans write their own nexus letter, which I have termed an Asbestos Exposure Summary Letter. Now let’s discuss what each of these nexus letters needs to say.
Doctor’s Nexus Letters for the VA
A common misconception among veterans is that you have to prove your cancer was from asbestos. Not true. The key to getting the VA to concede that your lung cancer is asbestos-related is convincing the VA that there is at least a 50% chance asbestos caused your lung cancer. Or, perhaps put another way, you must convince the VA asbestos was at least a 50% contributing factor in causing your lung cancer.
The VA has some very specific language they publish in the VA Clinician’s Guide that your doctor should use. The phrase is “at least as likely as not.” Seems like odd language, I know, but what it means is “at least a 50% chance.” As such, your doctor should explain the known causes of your type of cancer, explain how asbestos has been linked to it, and conclude that your lung cancer is “at least as likely as not to have been caused by asbestos.”
You may have to explain this wording to your doctor, as it may sound as alien to them as it does to you and me. I’ve had plenty of doctors write that their patient’s lung cancer is “at least as likely as not to have possibly been caused by asbestos.” And I have to tell the veteran that to the VA, the word “possibly” leaves too much wiggle room.
The words “possible” and “possibly” are the death knell of any asbestos claim. What does possible mean? 50% chance? 10% chance? 1% chance? Heck, even a 0.0001% chance your cancer is from asbestos is still “possible,” right? So, make sure your doctor doesn’t ever use these words in your nexus letter.
One more thing on this subject is that it is even better if your doctor is willing to attribute a greater than 50% chance of asbestos causing your lung cancer. Remember, asbestos causes lung cancer and asbestos was used in the military. The truth is the chance is likely greater than 50%. It’s 100% a lot of times! Asbestos did cause many veterans’ lung cancer. However, your doctor will most likely be unwilling to go this far.
So, all your doctor needs to say in that case is that your cancer is “more likely than not to have been caused by asbestos.”
There is one caveat that I should mention here: You don’t need a doctor’s nexus letter if you have been diagnosed with a disease only caused by asbestos. These include pleural mesothelioma, peritoneal mesothelioma, asbestosis and pleural plaque.
Key takeaway for you or a loved one: Get your doctor to write a VA nexus letter with specific language. Your cancer is “at least as likely as not to have been caused by asbestos.” This language will help get your VA claim approved.
Veterans Nexus Letters for the VA (Asbestos Exposure Summary Letters)
Once the nexus between your disability and asbestos has been established, the next letter, written by you, is going to need to convince the VA that your asbestos cancer is at least as likely as not to have been caused by your military service. To do this, your letter will need to convince the VA that you had at least as much exposure to asbestos in the military as you did in all your civilian jobs. Again, your military exposure must comprise at least 50% of your occupational exposure.
Also again, it’s likely that it did meet this 50% benchmark.
Proving this, however, requires as many details as you can provide. So you’ll need to provide examples of times when you either personally came in contact with asbestos in the military, or times when others were working with asbestos where you would have been similarly exposed because of the airborne asbestos created during their work.
In addition, you are going to need to provide a full history of all your civilian jobs, both before and after the military, and explain the kind of work you were doing. You will also need to explain any asbestos exposures you may have had in those jobs.
If you don’t know of any asbestos exposure in any of your civilian jobs, you should state that about each job. If you did have some exposure in your civilian jobs, you will need to explain why you believe it was not as significant as your exposure in the military.
I know, I know. How are you supposed to figure out where you had more exposure if you were exposed in both the military and any of your civilian jobs? It’s totally subjective and unknowable. But this is the way the VA is going to evaluate your claim, so this is the hand we have been dealt.
In some cases, it’s easy. If you were a boilerman in the Navy for four years, and then worked as a boilerman in a civilian job for a year after you left the Navy, four years trumps one year and it’s pretty easy to get approved.
But what if you were a boilerman in the Navy for four years, and then worked as an auto mechanic for 20 years? Working as a boilerman would have exposed you every day onboard a Navy ship. As an auto mechanic, you may have only been exposed occasionally while doing brake, clutch or gasket work.
In a case like this, you would have to convince the VA that the frequency of your exposure in the Navy was at least five times as often as your exposure as a mechanic (to make up for the 20-to-4 discrepancy in years on these jobs). You could also make the case that the work you did with asbestos in the Navy exposed you to a higher concentration of asbestos dust. This is where having a VA claims agent is immensely helpful.
Key takeaway for you or a loved one: Diseases only caused by asbestos only require you to convince the VA that at least 50% of your occupational asbestos exposure was in the military. Diseases with multiple known causes require you to get a doctor to write a nexus letter linking your disease to asbestos with at least a 50% probability.
Getting Help With Your VA Nexus Letters
If you need help getting your doctor to write a properly worded nexus letter, or if you need assistance in writing your Asbestos Exposure Summary Letter, I’m happy to help. In fact, I have many examples of doctor nexus letters and exposure summaries written by veterans with many different Ratings and Military Occupational Specialties.
You can reach me, Carl Jewett, LCDR, Retired at 844-838-6376 or email@example.com. If you have questions, you can also send me a message by clicking here.
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