The records to gather before you start

The single biggest thing that slows a nexus letter down is waiting on records. A physician cannot form an opinion about evidence they have not seen, and records requests to federal archives are measured in weeks, not days. If you do nothing else before starting, start these requests.

The four every case needs

1. 01Your DD-214 or equivalent separation document. This establishes your service dates, character of discharge, and often your occupational specialty.
2. 02Your service treatment records — the complete medical file from your time in service, including entrance and separation examinations.
3. 03Current medical records showing the diagnosis you are claiming, from whoever treats you now.
4. 04Any VA rating decision or denial letter you have received. If a claim was denied, the physician needs to read the VA's stated reasoning in order to address it.

Where to request each one

• DD-214 and service treatment records: request from the National Archives through the National Personnel Records Center. Many veterans who separated after roughly 2000 can also retrieve these through the VA's own online systems, which is considerably faster.
• VA treatment records: request through the release of information office at the VA medical centre where you are treated. Records from the last few years are often downloadable directly through the VA's patient portal.
• Private medical records: request directly from the provider or hospital. They must give them to you, though many charge a copying fee.
• Rating decisions and claim correspondence: available in your VA claims file, which you can request in full.

Condition-specific evidence

Beyond the core four, the diagnostic evidence for your particular condition matters. What that means depends on what you are claiming:

• Sleep apnea: the sleep study itself, not just a note that you have it. The physician needs the AHI and the study methodology.
• Spine and joint conditions: imaging reports — X-ray, MRI, or CT — and any surgical reports.
• Hearing loss and tinnitus: entrance and separation audiograms if they exist, plus a current audiology evaluation with word recognition scores.
• Mental health conditions: treatment notes, any psychological testing, and medication history.
• Neuropathy and radiculopathy: EMG or nerve conduction studies.
• Any medication-induced secondary claim: pharmacy records showing what you took and when.

Supporting evidence that helps

These are not medical records, but they frequently supply the in-service element that the medical records do not:

• Buddy statements from people who served with you and witnessed the event or your symptoms.
• A personal statement in your own words describing what happened and how the condition has progressed.
• Deployment records showing where you were and when, which matters enormously for exposure claims.
• Performance evaluations, which sometimes document a decline that nothing medical captured.