C&P Exams and Nexus Letters: What to Expect and What a Strong Opinion Contains

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The C&P exam

• VA must provide a medical exam when the record shows a current disability, an in-service event, and an indication they may be linked, but lacks enough evidence to decide — 38 CFR § 3.159(c)(4) (duty to assist).
• Exams are done by VA clinicians or contract vendors (e.g., QTC, Optum/LHI, VES). Examiners usually complete a Disability Benefits Questionnaire (DBQ). Public DBQs: https://www.va.gov/find-forms/about-form-21-0960/ (VA has withdrawn some public DBQs; check the list).
• Missing an exam without good cause can lead to the claim being decided on the record (original claim) or denied (increase claim) — 38 CFR § 3.655. Reschedule in advance if you must.
• Tips: describe your worst days and flare-ups (frequency, duration, what you cannot do); bring a list of meds and side effects; for joints, say when pain begins in range of motion (see 38 CFR §§ 4.40, 4.45, 4.59).
• Get your exam report: request it through VA.gov or a FOIA/Privacy Act request; review it for errors. If it is inadequate, raise it in a Higher-Level Review or supplemental claim.

The nexus letter (independent medical opinion)

VA weighs private opinions based on the examiner's qualifications, the facts reviewed, and the reasoning. A strong letter:

1. States the clinician's credentials and that they reviewed the service treatment records and claims file (list key records with dates).
2. Identifies the diagnosis.
3. Uses VA's standard: "at least as likely as not (50% or greater probability)" that the condition was caused by / is related to service, or for secondary claims "caused or aggravated" by the service-connected condition (38 CFR § 3.310).
4. Gives a medical rationale with literature where relevant — conclusions without reasoning get little weight.
5. Avoids speculative words ("could," "possibly") that VA treats as speculative.
6. Is signed, dated, on letterhead.

Lay evidence matters too: veterans and witnesses can describe symptoms they observe; use VA Form 21-10210 or 21-4138. Try our lay statement tool.