Gather Your Documents and Get a Nexus Opinion

Step 1 of the method is gathering your documents and getting a nexus opinion. It's where many veterans stall, so it's where the playbook starts. Three sets of records and one letter. The records say what happened. The letter says why it's connected to service.

If you don't know yet which conditions to claim, the free Claim Map shows what the VA rates in each part of the body.

Your service treatment records

The medical records from your time in uniform. Sick call notes, X-rays, the profile that limited your duty, your entrance and separation exams. Ask for your personnel file too.

These show what happened in service, written down at the time. Nobody can recreate that later. They don't prove you're disabled today, or that the two are connected. A thin file isn't a dead claim either. VA can still grant service connection for a disease diagnosed after discharge, when all the evidence shows you got it in service.

Your private medical records

Every doctor, clinic, therapist, and hospital that has treated you since you got out. Ask for the whole chart, not a summary. Your VA treatment records belong here too.

These prove you have the condition now and how long you've had it. They don't make the link. A chart note that reads "chronic low back pain" says nothing about where the pain came from.

Your DD-214

Your DD-214, your discharge papers, proves you're a veteran. Dates of service, character of discharge, your job, your decorations, and the campaigns you served in.

Dates and places open the presumptive routes, where you don't have to prove the link at all. A combat decoration matters too. The rule on reasonable doubt, below, can apply even without official records, especially for an incident in combat or similarly strenuous conditions. A DD-214 never proves anything medical.

Some of this is VA's job

Once your claim is in, VA has to help you build it. The rules call this the duty to assist.

VA will make reasonable efforts to help a claimant obtain evidence necessary to substantiate the claim. VA will not pay any fees charged by a custodian to provide records requested.

For federal records, such as service medical records and VA facility records, it goes further.

VA will make as many requests as are necessary to obtain relevant records from a Federal department or agency.

VA can only chase records you tell it about. You name who holds them, the rough dates, and what you were treated for. Gather your own copies anyway, so you read your file before a rater does.

The nexus opinion

A nexus opinion is a doctor's letter tying your condition to your service, or to a condition VA already rates. Nexus means link. It's the piece you can't write yourself.

VA's rules define who can give one.

Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions.

Your own doctor qualifies. The opinion carries more when they know your history and say they reviewed your records.

The wording is not decoration. "Could be related" and "possibly caused by" leave the question open. The phrase to ask for is at least as likely as not. The Board put that question to an examiner in citation 1812000.

Whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran's claimed low back disability had its onset during active service or is otherwise related to any in service disease, event, or injury.

Fifty percent or greater. The reason is the rule on reasonable doubt.

When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim.

An even split goes to you. Your doctor doesn't have to be certain, and it helps to say so when you ask.

A useful opinion names the diagnosis. It names the event in service, or the rated condition it grew out of. It uses the at least as likely as not sentence and gives the reasoning.

What our numbers show, and what they can't

Our decision pages count how often a Board decision mentions a medical opinion, by outcome.

On knee issues, 62 percent of granted issues sit in a decision that mentions a medical opinion. So do 63 percent of denied ones. On lower back issues it's 70 percent granted and 68 percent denied. Of the 51 condition families behind those pages, 40 have the two shares within five points. In 37 of the 51, the denied share is higher.

A mention is not a reason for the outcome. A count can't see whether the opinion was for the claim or against it. Each item is counted for the whole decision, so it may belong to another issue. These numbers are not evidence that an opinion improves your odds.

Here's what the duty to assist says. VA provides an exam or obtains an opinion only when the file lacks enough competent medical evidence to decide the claim. A claim with no medical link rests on what a VA examiner writes about you on one morning.

The Disability Benefits Questionnaire (DBQ)

A DBQ is VA's own exam form, one per condition, built around the rating criteria. It asks for the measurements that decide your percentage, and your doctor can fill one out. VA publishes them on its public DBQ list.

VA keeps some off the public list. They include hearing loss and tinnitus, initial PTSD (post-traumatic stress disorder), TBI (traumatic brain injury), cold injury, and the Gulf War general medical exam. For those your doctor writes a report in their own words and the VA exam supplies the form.

For joints, the rules say how the exam is done. A goniometer, the tool that measures angles, is indispensable in VA exams. Pain should be tested on active and passive motion, with weight on the joint and without. The exam should describe functional loss, meaning pain on use, weakness, and tiring out.

Exams that skip those get called out. In citation 19143628, the Board wrote this.

For the above reasons, the Board finds that the May 2016 VA examination was not adequate for rating purposes.

Hand your doctor the criteria first. The free Claim Map gives each condition's VA code and the percentages it can be rated at.

Your playbook sets out the rating ladder for your conditions, and has a chapter on gathering your documents. See what the playbook covers

Why the order matters

Hold your date first. Send VA an intent to file. If your complete claim arrives within a year of the day VA receives the intent to file, VA treats it as filed on that day. That rule doesn't apply to a supplemental claim.

Then do this before you file the full claim, not after. The rule on VA exams is the reason.

Provided that it is otherwise adequate for rating purposes, a statement from a private physician may be accepted for rating a claim without further examination.

When the evidence with the claim isn't adequate for rating purposes, the same rule authorizes a VA exam instead. You may be scheduled either way, and if you are, go. An opinion already in the file is one the examiner has to reckon with.

Here is the order I'd use.

1. Send VA an intent to file. Your year to finish the claim starts the day VA receives it.
2. Request your service treatment records and personnel file next. They take the longest.
3. Request your private records and your VA records while you wait.
4. Read your DD-214 against the presumptive routes.
5. Read all of it. Mark the sick call visit, the diagnosis, and the years between.
6. Take that stack to your doctor and ask for the opinion and the DBQ.
7. File the full claim with it attached before that year runs out. Name anyone else who holds your records, so VA can ask for them.

Doing it after you file still works. It just means a decision can land before your evidence does, and you build the same file again on appeal.

Step 2 is the rating criteria that apply to you. With two ratings in hand, read how the VA does the math.

I'm not your representative.