A nexus letter is not a strict legal requirement to file a claim, but it serves an important evidentiary function. To establish service connection — including secondary service connection under 38 CFR 3.310 — you generally need three things: a current diagnosis, an in-service event, injury, or a service-connected condition that could cause or aggravate the claimed condition, and medical evidence linking the two (the "nexus"). A private nexus letter from a treating physician is simply one common way to satisfy that third element, but it is not the only way.
You can submit medical literature, such as peer-reviewed studies showing a recognized link between conditions (for example, rhinitis and sleep apnea), as part of your evidence package. VA adjudicators and the C&P examiners who evaluate your claim are supposed to consider this literature, though it is often more persuasive when a medical professional applies it specifically to your case rather than being submitted as a standalone article. Filing without a signed nexus letter is possible, and the VA has a duty to assist that includes scheduling a Compensation and Pension exam when the evidence suggests a plausible link but is not fully developed. The C&P examiner can review the record, including any medical literature you submit, and render their own opinion on the nexus question.
Official 2026 VA monthly compensation, including the 2.8% COLA increase.
Dependent add-ons start at a 30% rating. Child-only and dependent-parent rates: see the full 2026 pay chart.
| Rating | Monthly (2026, incl. 2.8% COLA) |
|---|---|
| 10% | $180.42 |
| 20% | $356.66 |
| 30% | $552.47 |
| 40% | $795.84 |
| 50% | $1,132.90 |
| 60% | $1,435.02 |
| 70% | $1,808.45 |
| 80% | $2,102.15 |
| 90% | $2,362.30 |
| 100% | $3,938.58 |
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Analyze my claim free →That said, outcomes on secondary service connection claims vary widely, and evidence quality matters. At the Board of Veterans' Appeals, across issues decided from 1992 to July 2026, service-connection issues (2,302,001) came out 18.8% granted, 30.2% denied and 45.7% remanded (VetAid's Board outcome rates). These are outcomes for cases that were already appealed, not the odds of winning an initial claim, and appealed cases are not a random sample of all claims. If you can eventually find another provider, including a telehealth nexus letter service, that reviews your records and offers a reasoned opinion connecting the conditions, it will generally strengthen your file considerably.
As a next step, submit your claim with the supporting medical literature and any private treatment records you have, and consider requesting a formal C&P exam or seeking a nexus opinion from another qualified provider while the claim is pending.
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