"Not Incurred In or Caused By Service": Reading the Nexus Denial

The element being denied

Service connection requires three elements: a current disability, an in-service event, injury, or disease, and a nexus linking the two. Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd 78 F.3d 604 (Fed. Cir. 1996); Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). A denial almost always names which of the three VA found missing.

A nexus denial concedes elements one and two and rejects element three. That narrows what has to change on review — more treatment records for the current condition rarely move a nexus denial.

Where the negative opinion came from

Most nexus denials rest on a VA examination opinion phrased as 'less likely than not' related to service. The standard VA applies is at-least-as-likely-as-not: if the evidence is in relative equipoise, the benefit of the doubt goes to the claimant. 38 U.S.C. § 5107(b); 38 CFR § 3.102.

An opinion has to be more than a conclusion. Under Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), the probative value of a medical opinion comes from its reasoning, not from the examiner's credentials or the fact that the examiner reviewed the file. An opinion whose entire rationale is 'service treatment records are silent' is a recognized weak point, because Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006), holds that the absence of contemporaneous records cannot be the sole reason to reject lay evidence.

What actually addresses a nexus gap

• A medical opinion from a qualified provider that states the standard, reviews the relevant history, and explains the medical reasoning behind the conclusion.
• Continuity evidence: dated treatment records, prescriptions, or documented complaints bridging separation and the present.
• Lay statements describing observable symptoms over time — competent under Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007), for what a lay person can perceive.
• Medical literature addressing the mechanism, submitted alongside — not instead of — a case-specific opinion.

Fee rules after a decision

An accredited agent or attorney may charge for work only after VA issues a decision (38 U.S.C. § 5904(c)(1); 38 CFR § 14.636(c)). Nothing here predicts an outcome in any individual case.

Common missteps after a nexus denial

• ×Sending more records about how bad the condition is today; severity does not answer causation.
• ×Filing a Higher-Level Review when the file simply has no nexus opinion — HLR does not accept new evidence.
• ×Submitting an opinion with no rationale beyond 'in my opinion this is related to service.'

Frequently Asked Questions

References & sources

1. 38 CFR § 3.303 — Principles relating to service connection — Code of Federal Regulations
2. 38 CFR § 3.159 — VA's duty to assist — Code of Federal Regulations
3. 38 CFR § 3.2500 — Review of decisions (AMA lanes) — Code of Federal Regulations
4. Caluza v. Brown, 7 Vet. App. 498 (1995) — U.S. Court of Appeals for Veterans Claims · Sets out the three elements of service connection.