Medical Nexus Letter Template
For licensed clinicians providing an opinion on whether a condition is related to military service.
This template is guidance only. Clinicians should use their own judgment and language. Avoid boilerplate; provide a clear medical rationale.
1) Provider Information
Provider Name & Credentials
Specialty
License # / State
NPI
Practice Address
Phone
Email
2) Patient Information
Patient Name
Date of Birth
Last 4 (or File #)
3) Records Reviewed
Check or list the evidence reviewed for this opinion.
Service treatment records (STRs)
VA medical records
Private medical records
Lay/buddy statements
Imaging/lab results
Other (describe)
4) Current Diagnoses
5) Medical Opinion
Select one likelihood statement and provide a rationale in Section 6.
It is at least as likely as not (≥50% probability) that the patient’s condition is related to military service.
It is less likely than not (<50% probability) that the condition is related to military service.
The condition was aggravated beyond its natural progression by a service-connected condition.
6) Rationale
Explain the medical reasoning, referencing records, exam findings, and accepted principles. Address alternative causes if applicable.
7) Signature
Provider Signature
Printed Name & Credentials
Date
License # / State
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