What does the VA require to grant service connection?
Direct service connection requires three things: a current diagnosed disability, an in-service event or injury or illness, and a medical nexus linking the two. Missing any one of them results in a denial.
Almost every denial of direct service connection traces back to one of these three. Knowing which one a decision is pointing at is what makes the letter readable.
1. A current disability
There has to be a diagnosed disability now, documented in the record. 1
This is the element veterans find most counterintuitive, because a claim can be denied for lack of a current disability even when the service records clearly show treatment for the same problem. Being hurt in service is not the same as having a documented diagnosis today. Symptoms without a diagnosis, or a condition that resolved and left no current findings, will not satisfy it.
When a decision says something like "the evidence does not establish a current diagnosed disability," this is the element that failed.
2. An in-service event, injury, or illness
Something has to have happened in service. 1 That can be a documented injury, an illness, an exposure, or the cumulative effect of duties over time.
Service treatment records are the usual proof. When records are thin or missing, lay evidence including buddy statements from people who served alongside you can help establish that an event occurred.
3. A nexus
The link. Medical evidence connecting the current disability to the in-service event. 1
This is where the largest share of denials land, and it is where the phrase at least as likely as not comes from. That standard means a 50 percent probability or greater. It is a lower bar than most people assume, because the VA is not asking for certainty.
A nexus opinion generally comes from a qualified medical professional and carries weight based on the reasoning behind it rather than the credentials alone. 2
The benefit of the doubt
When the evidence for and against a claim is in approximate balance, the regulation says the benefit of the doubt goes to the veteran. 3 This is why the standard is at least as likely as not rather than more likely than not.
When a decision states that the benefit of the doubt doctrine is not for application, it means the VA did not consider the evidence close enough to be a tie.
Other routes to service connection
Direct service connection is not the only path.
Secondary service connection covers conditions caused or aggravated by an already service-connected condition. 4
Presumptive service connection covers specific conditions the VA presumes are related to service based on where and when someone served, including many toxic exposure conditions. Presumptive claims do not require a nexus opinion, because the connection is presumed.
What this means for reading a denial
A denial names which element failed, in its own language. Once you can tell whether the VA is saying there is no current diagnosis, no in-service event, or no link, the letter stops being a wall and becomes specific.
An accredited VSO can review a decision at no cost.