Veterans Benefits Toolkit: Evidence, Nexus Letters, and Appeal Lanes

SECTION A—RECORDS

A-1. Claims file (C-file) request

Re: Request for a complete copy of my claims file—[Name], VA File No. [], SSN [last four], DOB []

Pursuant to the Privacy Act and 38 C.F.R. § 1.577, I request a complete copy of my claims file, including: all rating decisions and code sheets; all VA examination reports; all service treatment and personnel records in the file; all correspondence; all medical evidence; and all internal worksheets and deferred rating documents.

Please provide it in electronic format. If any portion is withheld, identify the record and the exemption claimed.

[Signature · date · address · telephone]

A-2. Records request checklist

□ SERVICE TREATMENT RECORDS—National Personnel Records Center
                                or the VA portal
□ PERSONNEL FILE (OMPF)—duty assignments, LOCATIONS, DATES
                                (proves exposure for presumptives)
□ CLAIMS FILE (C-file)—what adjudicators actually read
□ PRIVATE TREATMENT RECORDS—request directly; faster, and you
                                control completeness
□ SSA DISABILITY FILE—functional evidence for TDIU
□ UNIT RECORDS / AFTER-ACTION REPORTS / MORNING REPORTS—for stressor corroboration
□ DD-214 and any prior DD-215
□ Prior C&P examination reports

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SECTION B—WORKSHEETS

B-1. Condition inventory

Claim everything, including at 0%. A 0% grant establishes service connection—the foundation for later increases and every secondary claim.

B-2. Secondary condition map—the most underclaimed part of the system

B-3. Combined ratings calculator—why ratings do not add

Start at 100% EFFICIENCY. Apply each rating to what REMAINS.

  Ratings, highest first:  50%, 30%, 20%

  Step 1: 50% of 100 = 50   → combined 50, efficiency 50
  Step 2: 30% of 50  = 15   → combined 65, efficiency 35
  Step 3: 20% of 35  = 7    → combined 72, efficiency 28

  ROUND to the nearest 10  →  70% COMBINED

Three ratings "totaling 100" produce 70.

YOUR CALCULATION
  Ratings, highest first: ____ ____ ____ ____ ____
  Step 1: ____ of 100 = ____  → combined ____, remaining ____
  Step 2: ____ of ____ = ____ → combined ____, remaining ____
  Step 3: ____ of ____ = ____ → combined ____, remaining ____
  Rounded: ______%

⚠ ADD the BILATERAL FACTOR where there are compensable disabilities
  of both arms, both legs, or paired skeletal muscles.
⚠ The marginal value of an additional low rating falls sharply as
  the combined figure rises—which is why TDIU and SMC are usually
  worth more than one more 10%.

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SECTION C—THE EVIDENCE THAT DECIDES CLAIMS

C-1. Nexus letter—direct service connection

[Provider letterhead] · [Date]

Re: [Veteran], DOB [__]—Medical opinion regarding [condition]

Qualifications. I am a [board-certified specialty] licensed in [state]. I have treated [Veteran] since [date] [or: I examined [Veteran] on [date] for the purpose of this opinion].

Records reviewed. I reviewed: the service treatment records dated [range], including the entries of [dates]; the DD-214; VA treatment records dated [range]; the VA examination report dated [date]; and imaging dated [dates].

Diagnosis. [Veteran] has [diagnosis], confirmed by [basis].

Opinion. It is my opinion that [Veteran]'s [condition] is at least as likely as not (50 percent probability or greater) related to [his/her/their] active military service.

Rationale.

1. The service treatment records document [the injury/exposure] on [date], with complaints of [symptoms] recorded on [dates].
2. [Mechanism: why this event produces this condition, in medical terms.]
3. [Chronology: the pattern and progression, and why it is consistent with a service origin.]
4. [Absence of intervening cause: no documented intervening trauma or alternative etiology.]
5. [Where relevant: the medical literature supporting the association.]

Response to the VA examination. The examiner concluded [X], reasoning that [Y]. I respectfully disagree because [specific medical response—e.g., gaps in treatment do not indicate resolution in a population without health coverage; the pattern is unilateral and post-traumatic rather than age-related].

[Signature · printed name · credentials · NPI · telephone]

*Four things make this work: the records reviewed are identified; the opinion uses "at least as likely as not"; there is a rationale, not a conclusion; and it answers the negative examiner directly.*

C-2. Nexus letter—secondary service connection or aggravation

Opinion (secondary causation). It is my opinion that [Veteran]'s [condition B] is at least as likely as not caused by [his/her/their] service-connected [condition A].

Opinion (aggravation)—state this separately, because it is a separate theory. It is further my opinion that, if [condition B] is not caused by [condition A], it is at least as likely as not aggravated beyond its natural progression by [condition A]. The baseline level of severity before aggravation was [describe], and the current level is [describe].

Rationale. [The physiological mechanism linking A to B—e.g., chronic pain and sleep disruption producing major depressive disorder; weight gain from a service-connected condition and its medication producing or worsening obstructive sleep apnea; altered gait producing contralateral joint degeneration.] [Then: literature; then: absence of alternative explanation.]

Aggravation must be stated as its own opinion with a baseline, or it is not adjudicated.

C-3. Veteran lay statement

STATEMENT IN SUPPORT OF CLAIM—[Name], VA File No. ____

WHAT HAPPENED IN SERVICE
  In [month, year], while assigned to [unit] at [location], I
  [describe the event in plain first-person language]. I [did / did
  not] report it, because ______.

WHAT I EXPERIENCED THEN
  [Symptoms at the time; who else knew; what I did about it.]

WHAT HAS HAPPENED SINCE  (continuity—this is the point)
  After separation in [year], I [symptoms]. I did not seek care
  between ____ and ____ because ______ [no coverage, no VA nearby,
  did not know I could claim it].
  I first sought treatment on [date] with [provider].

WHAT IT IS LIKE NOW  (functional, specific, frequency and duration)
  · I can ______ for about ____ minutes before ______.
  · I stopped ______ in [year].
  · I miss about ____ days of work per month.
  · On a bad day, which happens about ____ times a week, I ______.

I certify the foregoing is true to the best of my knowledge.
______________________  Date: __________

C-4. Buddy statement—often the only evidence of an unreported event

I, [Name], served with [Veteran] in [unit] at [location] from [date] to [date]. My rank at the time was [__].

What I saw. [Specific: "In about March 2004, during a road march near [location], I saw [Veteran] fall and twist his knee. He finished the march limping. Over the following weeks I saw him wrap the knee and skip PT."]

What I observed afterward. [Changes in behavior, performance, or health that I personally observed.]

I am providing this statement of my own knowledge. My contact information is [phone/email].

______________________ Date: __________

C-5. Employer statement—the document that wins TDIU

Re: [Veteran], employed [dates], as [position]

I am [title] at [employer] and was [Veteran]'s [supervisor/owner].

The work. [Veteran] worked [hours per week] as a [position], earning $[__] per [period].

Accommodations provided. [Specific: permitted to leave without notice when symptoms occurred; given a modified schedule; excused from [tasks]; provided a private space; allowed unscheduled breaks totaling about ___ per day.]

Absences. [Veteran] missed approximately [] days in the last [12] months, of which [] were unscheduled. A person in this position without these accommodations would [not have been retained / have been terminated after ___].

Productivity. [Veteran] performed at approximately [__]% of the output expected of others in the position.

Relationship. [Where applicable: [Veteran] is my [relation], and the position was created to accommodate [him/her/them]. It is not a position I would fill from the open market.]

[Signature · title · direct telephone]

"Marginal employment"—earnings below the poverty threshold, or work in a protected environment—does not defeat TDIU. This letter is how that is proved.

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SECTION D—THE EXAMINATION

D-1. Preparation sheet (bring it with you)

CONDITION: ______________  DIAGNOSTIC CODE: ______
RATING CRITERIA AT THE NEXT LEVEL UP:
  ______________________________________________

DIAGNOSES: ____________________________________
PROVIDERS: ____________________________________
MEDICATIONS (and side effects): ________________

SYMPTOM LOG—LAST 30 DAYS
  Bad days: ____ of 30.  On a bad day I cannot: ______________
  Average day: I can ______ for ____ minutes before ______
  Flare-ups: ____ per month, lasting ______, treated by ______
  Sleep: ____ hours; interrupted ____ times
  Work missed: ____ days
  Activities STOPPED, and when: ____________________

WHAT I WILL SAY
  · Describe the WORST and AVERAGE, not the best
  · Frequency, duration, and what I have stopped doing
  · Nothing exaggerated

D-2. Examination adequacy review (after you get the report)

□ Does the report state the examiner REVIEWED THE CLAIMS FILE?
□ Were ALL claimed conditions addressed?
□ Were ALL theories addressed—direct, SECONDARY, AGGRAVATION?
  (Aggravation requires a separate opinion WITH A BASELINE.)
□ Does the opinion use "AT LEAST AS LIKELY AS NOT"?
□ Is there a RATIONALE, or only a conclusion?
□ Does the rationale rest on a correct factual premise?
  (Common error: "no in-service treatment" when the records show it.)
□ For musculoskeletal: were FLARE-UPS and REPETITIVE USE addressed?
  Was FUNCTIONAL LOSS considered, not only range of motion?
□ For mental health: was OCCUPATIONAL AND SOCIAL IMPAIRMENT
  addressed, or only a symptom list?
□ Were the veteran's lay statements acknowledged?

IF ANY BOX FAILS → write to VA identifying the specific defect and
requesting a new examination. Duty to assist requires an ADEQUATE
examination; inadequacy is an appeal ground.

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SECTION E—DECISION ANALYSIS AND LANE SELECTION

E-1. Decision letter analysis

1. "EVIDENCE" LIST—is everything you submitted listed?
   Missing item: ____________  → DUTY TO ASSIST ground

2. "REASONS FOR DECISION"—which ELEMENT failed?
   □ Current disability   □ In-service event   □ NEXUS
   □ Severity / rating criteria   □ Reasons and bases

3. RATING ARITHMETIC—run B-3. Correct?  □ Yes  □ No

4. EFFECTIVE DATE—intent to file? within a year of separation?
   increase ascertainable up to a year before filing?

5. STAGED RATINGS—did severity vary over the period?

6. SEPARATE RATINGS—distinct symptoms rated separately?
   (Radiculopathy · scars · associated conditions)

E-2. Lane selection matrix—one year from the decision

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SECTION F—APPEAL FILINGS

F-1. Supplemental claim cover statement

Re: Supplemental claim—[Name], VA File No. []—Decision dated []

This supplemental claim is filed within one year of the decision dated [__], which denied service connection for [condition] on the ground that [quote the stated reason].

New and relevant evidence submitted with this claim:

1. Medical opinion of [provider], dated [__] (Exhibit A). Dr. [__] reviewed the service treatment records and the VA examination report and opines that the condition is at least as likely as not related to service. This evidence is new—it was not of record—and relevant, because it tends to prove the nexus element the prior decision found unproven.
2. Buddy statement of [name], dated [__] (Exhibit B), corroborating the in-service event.
3. [Additional evidence.]

Request. That service connection be granted, effective [intent-to-file date / original claim date], and that VA's duty to assist be applied to obtain [any outstanding records identified].

F-2. Higher-level review request—points to raise

NO NEW EVIDENCE MAY BE SUBMITTED. Identify the ERROR in the record.

□ REQUEST THE INFORMAL CONFERENCE—and prepare for it.

ERRORS TO IDENTIFY (cite page and date for each)
  □ The rating criteria were misapplied. The record at [pages]
    documents [findings], which meet the ___% criteria because
    ______________.
  □ The combined rating was miscalculated. Correct calculation: ___
  □ The effective date is wrong. [Intent to file dated ___ /
    claim within one year of separation / increase ascertainable
    from records dated ___.]
  □ Favorable evidence at [page] was not addressed.
  □ The benefit of the doubt was not applied although the evidence
    is in approximate balance. 38 U.S.C. § 5107(b).
  □ A separate rating is warranted for [distinct symptoms].
  □ Staged ratings are warranted for [period].
  □ A duty-to-assist error: [identified records never obtained /
    inadequate examination].

F-3. Board appeal—choosing the option

□ DIRECT REVIEW      No new evidence · no hearing · FASTEST
                     Use when the record supports the grant and the
                     issue is legal.
□ EVIDENCE SUBMISSION  90 days to submit · no hearing
                     Use when you have evidence but not testimony.
□ HEARING            Before a Veterans Law Judge · 90-day
                     post-hearing window · SLOWEST BY FAR
                     Use ONLY where credibility genuinely matters:
                     an unreported in-service event, or a file that
                     understates impairment in a way a person
                     present can convey.

ISSUES TO PRESERVE IN EVERY BOARD APPEAL
  □ Benefit of the doubt, 38 U.S.C. § 5107(b)
  □ Duty to assist, 38 U.S.C. § 5103A
  □ Adequate reasons and bases
  □ Every theory: direct · presumptive · secondary · AGGRAVATION
  □ TDIU, where employment is affected (raised by the record)

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SECTION G—TDIU AND SURVIVORS

G-1. TDIU package

□ Schedular threshold: one disability ≥60%, OR combined ≥70% with
  one ≥40%.  (Below? Request EXTRASCHEDULAR referral.)
□ The TDIU form—FILED, not left to inference
□ Employment history: every job, dates, hours, reason for leaving
□ EMPLOYER STATEMENT (C-5)—accommodations, absences, productivity,
  and whether the position is protected
□ VOCATIONAL EXPERT OPINION tying service-connected limitations to
  inability to sustain substantially gainful employment
□ SSA disability determination and file
□ Treatment records showing functional limitation
□ Veteran's own statement on work attempts and why they failed
□ Earnings records (marginal employment = below the poverty
  threshold, or a protected environment)

⚠ WORKING DOES NOT DEFEAT THE CLAIM.

G-2. Survivor claims (DIC and related)

□ DIC—veteran died OF a service-connected condition, OR was
  continuously rated TOTALLY DISABLED for the required period
  before death. Substantial; routinely never claimed.
□ ACCRUED BENEFITS—for a claim pending at the veteran's death
□ SUBSTITUTION—the survivor may substitute into a pending claim
□ Burial allowance · plot allowance · headstone or marker ·
  national cemetery interment
□ SURVIVORS PENSION (needs-based, wartime service)
□ DEA / Fry Scholarship education benefits for dependents
□ CHAMPVA health coverage
□ Home loan guaranty eligibility for a surviving spouse
□ STATE survivor benefits—ask a county/state veterans service
  officer

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SECTION H—PRIMARY AUTHORITY

• 38 U.S.C. § 1110—basic entitlement.
• 38 U.S.C. § 1155—the rating schedule.
• 38 U.S.C. § 5103—notice and the duty to assist.
• 38 U.S.C. § 5107—benefit of the doubt.
• 38 U.S.C. § 7104—the Board.
• 38 U.S.C. § 7252—the Court of Appeals for Veterans Claims.
• 38 C.F.R. Part 3 (adjudication, presumptions, effective dates) and Part 4 (rating schedule, § 4.25 combined ratings, § 4.16 TDIU); the Veterans Appeals Improvement and Modernization Act; the PACT Act; the Equal Access to Justice Act.

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Related documents

• Veterans Benefits
• Filing and Appealing a VA Disability Claim
• VA Disability Claim and Appeal Checklist
• Social Security Disability Toolkit
• Elder Law Toolkit
• Expungement and Record Relief Toolkit

This toolkit is educational and not legal advice. VA regulations, presumptive lists, and rating criteria change. Adapt every template, and consult an accredited representative—VSO services are free.