What Gives a Nexus Opinion Probative Value? (Winning on the 50-Yard Line)

In the world of VA disability law, the phrase "at least as likely as not" is the magic incantation. It's the 50-yard line, the legal standard for equipoise that determines whether a veteran wins their claim. As an attorney, you know this standard by heart.

So why do so many C&P examiners and adjudicators get it wrong?

You submit a nexus letter from a qualified physician stating those exact words, only to see the BVA reject it. The answer is the gap between the standard and the substance. The BVA doesn't just "count" opinions; it weighs them. Your expert's opinion is only as good as its probative value.

The Conclusory Trap: Why So Many Nexus Letters Fail

A "conclusory" opinion is the number one reason an otherwise good claim fails. You've seen the BVA's language: "The Board finds Dr. Smith's opinion has little probative value as it is conclusory and provides no supporting rationale." This happens when an expert offers a conclusion without showing their work, forcing the BVA to "take the expert's word for it," which they cannot and will not do.

The C&P Examiner's "Certainty Trap"

This problem is often compounded by C&P examiners who apply the wrong standard. They deny claims because there is no "definitive proof" or "absolute certainty". They mistake the absence of overwhelming in-service documentation as evidence against the claim. A veteran does not need to prove with 100% certainty that their service caused their condition; they only need to show it is at least as likely as not.

The Power of a "Soundly Reasoned" Opinion

The BVA isn't looking for the most "certain" opinion; it's looking for the most probative one. The strength of an opinion lies not in the certainty of its conclusion, but in the soundness of its reasoning.

A high-value, probative opinion is a defensible argument built on three pillars:

Pillar 1: A Clear, Specific Rationale (The "Why")

This is the medical logic. It's the step-by-step pathophysiologic explanation that connects the in-service event to the current condition.

• Weak Opinion: "The veteran's TBI is at least as likely as not related to his 2010 IED blast."
• Probative Opinion: "The veteran's in-service TBI is the established etiological cause of his current chronic migraines. The pathophysiological mechanism is well-documented: the blast wave caused a neurometabolic cascade that led to a state of chronic neuronal hyperexcitability, which now manifests as..."

Pillar 2: A Thorough Review of the Record (The "What")

An opinion cannot exist in a vacuum. It must be explicitly anchored in the specific evidence from the veteran's C-file. A probative opinion must affirmatively state what records were reviewed, reference specific evidence, and confront any unfavorable evidence. This neutralizes the C&P examiner's primary line of attack.

Pillar 3: Support from Peer-Reviewed Literature (The "Proof")

This is the "Evidence-Based" component that makes an opinion nearly irrefutable. It elevates the opinion from a personal belief to the consensus of the medical community.

• C&P examiner (speculates): "In my medical experience, this condition is not related."
• Probative Opinion (counters with facts): "While the C&P examiner speculates, their opinion is contradicted by the medical literature. A 2021 meta-analysis in The Journal of Bone & Joint Surgery confirms a strong relationship between high-impact mechanical loading (like parachute jumps) and the early onset of lumbar spondylosis..."