Nexus Letter Visual Guide Library

16 printable one-page charts on nexus letters and private medical opinions: when you need one, what a strong one says, the probability wording VA looks for, and how the Board weighs conflicting opinions.

16 visual guides. 2 research charts refresh weekly from RateMyVSO's analysis of 1,897,000+ published BVA decisions; each chart prints its own sample size. The other 14 do not: a third research chart, on opinion conflicts at the Board, is a fixed snapshot dated on the chart, and the rest state the nexus-letter rules, the medical-opinion tests, or the roadmaps, and change only when the law does.

All 16 visual guides

One-page guide showing the building blocks of a persuasive VA nexus opinion, including the correct veteran and condition, evidence reviewed, clear probability language, medical reasoning, alternative explanations, provider credentials, and a final quality check. — Core Guide **Strong VA Nexus Letter in One Page** View full size · Download PNG · Download PDF

Decision guide showing when a separate nexus letter may help a VA disability claim, when an existing medical opinion may already address the link, and when the missing issue is diagnosis, in-service evidence, or severity rather than nexus. — Core Guide **Do You Need a Nexus Letter?** View full size · Download PNG · Download PDF

Annotated medical-opinion structure showing the veteran and provider details, records reviewed, medical question, probability conclusion, reasoned analysis, supporting evidence, alternative explanations, and signature and credentials. — Core Guide **Anatomy of a Strong Nexus Letter** View full size · Download PNG · Download PDF

Side-by-side comparison of a strong VA medical opinion with a weak one, emphasizing accurate facts, clear probability language, condition-specific reasoning, medical support, alternative causes, and a complete signature. — Core Guide **Good vs Weak Medical Opinion** View full size · Download PNG · Download PDF

Guide to VA medical-opinion probability language, distinguishing favorable at-least-as-likely-as-not language from speculative or unfavorable wording and explaining that reasoning matters more than a phrase alone. — Core Guide **Medical Opinion Language Explained** View full size · Download PNG · Download PDF

Checklist of records to organize for a medical nexus review, including the decision question, relevant service records, current diagnosis and treatment, timeline, lay evidence, prior examinations, favorable and unfavorable evidence, and medication or treatment effects. — Core Guide **Nexus Evidence Packet Checklist** View full size · Download PNG · Download PDF

Practical sequence for asking a treating clinician for a VA medical opinion without pressuring the clinician, including preparing a concise packet, asking whether the clinician can give an independent opinion, and respecting a refusal. — Core Guide **How to Ask Your Doctor for a Nexus Letter** View full size · Download PNG · Download PDF

Comparison of VA examiners, treating clinicians, independent private clinicians, and record-review opinions, with reminders that credentials, factual accuracy, scope, and medical reasoning determine weight. — Core Guide **Where VA Nexus Opinions Come From** View full size · Download PNG · Download PDF

Warning guide listing common medical-opinion problems such as factual errors, conclusory language, missing rationale, unsupported certainty, ignored contrary evidence, copied boilerplate, unclear credentials, and opinions outside the provider's expertise. — Core Guide **Nexus Letter Red Flags** View full size · Download PNG · Download PDF

Flowchart connecting a current diagnosis, an in-service event or exposure, and a medical opinion that explains why the current condition is at least as likely as not related to service. — Core Guide **Direct Service Connection Nexus Roadmap** View full size · Download PNG · Download PDF

Flowchart for a condition claimed secondary to an established service-connected disability, separating causation from aggravation and requiring a medical explanation for the claimed direction. — Core Guide **Secondary Condition Nexus Roadmap** View full size · Download PNG · Download PDF

Guide to secondary aggravation opinions showing the baseline level when it can be identified, the current level, the service-connected influence, the increase attributable to aggravation, and the rule that permanent worsening is not required. — Core Guide **Aggravation Medical Opinion Guide** View full size · Download PNG · Download PDF

Reference sheet explaining that VA weighs examiner competence, accurate facts, review scope, clear conclusions, reasoned analysis, supporting evidence, treatment familiarity, and responses to contrary evidence rather than favoring an opinion by source alone. — Core Guide **How VA Weighs Medical Opinions** View full size · Download PNG · Download PDF

Board grant-rate comparison with and without a detected private medical opinion, current edge 37.5 percentage points, 79.8 percent granted with versus 42.3 percent without. — Research **The Private-Opinion Edge Over Time** View full size · Download PNG · Download PDF

Board grant-rate comparison by condition with and without a detected private medical opinion, Gastroesophageal reflux disease shows the highest edge at 51.3 percentage points. — Research **Private Opinion Outcomes by Condition** View full size · Download PNG · Download PDF

Two outcome charts for published Board decisions that mention both a private opinion and examiner or explicitly cite Nieves-Rodriguez, with granted, denied, mixed, and remanded shares and classification limits. — Research **Medical Opinion Conflicts at the Board** View full size · Download PNG · Download PDF

How to use this library

Every guide is a single tall image sized for printing or saving to your phone. Select any card to open the full-resolution image, or use the download link under it. The rule and roadmap charts summarize the published criteria; the research charts report what RateMyVSO measured in published Board decisions, with the population printed on the chart itself.

These charts catalogue published rules and observed Board outcomes. They do not predict any individual claim and are not legal or medical advice. For the full written guidance behind them, start with the Nexus Letters guide.

Common Questions

Can I download, print, and share these guides?

Yes. Every guide has a free full-resolution PNG download, sized for printing on letter paper or reading on a phone. Share them freely; please keep the footer attribution intact so readers can find the underlying data.

How current are the research numbers?

The two weekly research charts are rebuilt from the same data files that power this site's live Nexus Trend Report. Each chart prints the generation date of its own data sources in the footer, so you always know exactly when its numbers were produced.

Do these charts predict my claim?

No. They report what happened in published Board of Veterans' Appeals decisions, which are appeals, not initial claims, and are described with their exact sample on each chart. An observed grant share is a description of past decided cases, never a probability for any individual claim.

Related Tools and Guides

Nexus Letters Guide

The written guidance behind these charts, from what a nexus letter is through where to get one.

Nexus Trend Report

The live version of the private-opinion research charts, updated weekly.

How VA Weighs Medical Opinions

The full written guidance behind the opinion-weighing and conflicts charts.

All Visual Guide Libraries

Every RateMyVSO visual guide collection in one place.

Educational use only. These visual guides catalogue published VA rules and observed outcomes in published Board of Veterans' Appeals decisions. They are not legal or medical advice, do not predict any individual claim, and are not affiliated with the Department of Veterans Affairs. Sample sizes and data dates are printed on each chart.