Step 4: Understand How Your Condition Is Being Connected

Before filing, understand how the condition you are claiming is allegedly connected to military service. This is especially important when you already have a Nexus Letter.

There are several common paths to service connection.

Direct service connection

A condition may be directly connected to something that happened during military service.

For example:

Current lumbar condition related to an injury sustained during active military service.

For a direct claim, the VA generally looks for evidence of a current condition, an in-service event, injury, or disease, and a connection between the two.

Secondary service connection

A secondary condition is a new disability linked to a disability the VA has already determined is service connected.

For example:

Migraine headaches secondary to service-connected tinnitus.

The VA states that a secondary claim generally requires evidence of the new condition and evidence of a link between that condition and an already service-connected disability.

Secondary service connection can also involve situations where an already service-connected disability aggravates another condition.

Presumptive service connection

For certain conditions and qualifying service circumstances, the VA may presume a relationship between military service and the disability.

This can apply to certain exposures, locations, periods of service, chronic conditions, and other circumstances established under federal law and VA regulations.

A Veteran who qualifies for presumptive service connection may not need the same type of individualized nexus evidence that another claim would require.

Step 5: Look at What Your Nexus Letter Actually Says

This is important — learn the details of your letter. Your Nexus Letter should identify the medical relationship the provider evaluated.

Try to describe your claim consistently with the medical theory actually addressed by the letter.

For example, suppose your Nexus Letter evaluates:

Lower Back Pain is secondary to service-connected Arthritis in the Knees altering how you walk.

That is different from claiming:

Lower Back Pain was directly caused by falling out of a truck during active duty.

Those are different theories of service connection and may involve different evidence.

The Nexus Letter is medical evidence supporting a particular medical relationship. Make sure you understand what relationship your provider actually evaluated.