VA NEXUS LETTERS for Veterans
Independent Medical Opinion Letters
by Fellowship-Trained Medical Experts
VA NEXUS LETTERS for Veterans
Independent Medical Opinion Letters
by Fellowship-Trained Medical Experts
Independent, evidence-based VA Nexus Letters for Veterans and attorneys
At David Medical Services, we provide medically rigorous nexus letters that clearly connect military service to current medical conditions. Our physician-led team includes fellowship-trained physicians in occupational/environmental medicine and addiction medicine, with experience in evaluating toxic exposures, occupational hazards, functional limitations, and complex medical causation to help Veterans and their representatives present strong, well-supported VA disability claims.
Medical Nexus Letter Opinions That Stand Up to VA Scrutiny
A nexus letter can determine whether a VA claim succeeds or fails.
We focus on what matters most:
- Clear, legally relevant medical reasoning
- Evidence-based opinions supported by medical literature
- Language aligned with VA adjudication standards
- Independent, unbiased medical analysis
Every DMS nexus letter is a unique, carefully prepared document
by a licensed, residency- and fellowship-trained MD physician—
not a generated template or outsourced report.
Specialized Expertise for Complex VA Claims
Our physicians routinely evaluate common chronic medical conditions for plausible service connections. In addition, our background in occupational & environmental medicine and addiction medicine allows us to address medically complex cases that are often denied without expert support.
Occupational & Environmental Medicine Nexus Letters
We evaluate conditions related to:
- Military occupational exposures
- Environmental and toxic exposures
- Chemical, airborne, and workplace hazards
- Long-term health effects of service-related exposures
These claims often require detailed exposure analysis and medical reasoning—our specialty.
Addiction Medicine Nexus Letters
We also provide nexus opinions addressing:
- Substance use disorders secondary to service-connected pain and other conditions
- Alcohol or opioid use disorder linked to chronic pain, PTSD, or mental health conditions
- Medication-related dependency and long-term consequences
Addiction medicine claims are frequently misunderstood or minimized by the VA. We provide clear medical explanations that connect addiction to underlying service-connected conditions when appropriate.
General Medical Nexus Letters
We provide MD physician-authored medical nexus letters for common medical conditions when supported by the medical record and current medical evidence. These opinions may address conditions such as degenerative joint or spine disease, obstructive sleep apnea, musculoskeletal disorders, chronic pain syndromes, and other chronic medical diagnoses.
Why our nexus letters are different
A strong VA nexus letter requires more than a diagnosis. It requires a clear, medically sound explanation connecting a Veteran's current condition to military service or an already service-connected condition.
Our medical nexus opinions are different because we:
- Perform a comprehensive review of medical records and service history
- Use current peer-reviewed medical research when clinically appropriate
- Clearly explain medical reasoning and pathophysiology
- Apply VA standards, including the "at least as likely as not" threshold
Each nexus letter is written by a licensed MD physician and reflects an independent medical opinion, not templated language or prewritten narratives. Learn more.
Why Veterans Choose Nexus Letters by David Medical Services
- Residency- and Fellowship-trained physicians
- Occupational & environmental medicine expertise
- Addiction medicine expertise for secondary claims
- Independent, unbiased medical opinions
- Clear, professional documentation aligned with VA standards
- No guarantees, no exaggeration - just honest medical analysis
We provide credible medical opinions grounded in science and clinical judgment.
Learn more about our physicians and their clinical backgrounds.
Serving Veterans and VA Disability Attorneys
We work with:
- Veterans pursuing initial claims, secondary claims, or appeals
- VA disability attorneys seeking independent medical expert opinions
- Advocates and representatives who need thorough medical documentation
Our reports are structured to be attorney-friendly and VA-ready, helping legal teams present persuasive medical evidence.
Medical opinions for Federal Disability Accommodations
In select cases, we provide medical opinions for veterans with already service-connected conditions who require documentation for federal workplace accommodations. These evaluations focus on how medical limitations impact essential job functions, and whether requested accommodations are medically reasonable.
This specialty nexus letter service is offered on a case-by-case basis and is not intended for VA disability claims or rating increases. To learn more, visit our Medical Opinions for Federal Disability Accommodations page.
Note: This service is for veterans who already have service-connected conditions.
Frequently Asked Questions
View the full Nexus Letter FAQ
A VA nexus letter is a medical opinion that explains whether a Veteran's current medical condition is at least as likely as not related to military service. It is based on a review of medical records, service history, and relevant medical literature. The letter helps clarify the medical connection but does not determine VA outcomes.
Our nexus letters are written by licensed MD physicians with formal training in internal medicine, occupational & environmental medicine, addiction medicine, preventive medicine, and public health. In addition, they have years of experience diagnosing and managing chronic primary care conditions. Each opinion is developed independently, using evidence-based reasoning and accepted medical standards. We do not use templates or non-physician writers.
No. Ethical medical opinions cannot guarantee VA decisions. Our role is to provide an objective, medically supported opinion based on the available evidence, not to advocate for or predict outcomes.
We commonly evaluate chronic medical conditions such as hypertension, sleep apnea, tinnitus, and others for plausible service connections. In addition, our physicians have specialized expertise to evaluate conditions related to toxic, occupational, and environmental exposures, as well as secondary substance use disorders. Our occupational medicine physician can also provide independent medical opinions for veterans with already service-connected conditions who require documentation for federal workplace accommodations.
Most nexus letters are completed within 2-3 weeks, after all required records are received. Timelines vary depending on the complexity of the case and the research required to support the nexus opinion. You'll be informed early in the process if additional information is needed.
David Medical Services provides independent VA nexus letters for Veterans nationwide, with specialized expertise in occupational medicine, environmental exposure, and addiction medicine. Our physician-led services support VA disability claims, appeals, and secondary service connection cases.