This page answers common questions about
VA nexus letters, independent medical opinions, and our medical review process.
A VA medical nexus letter is a medical opinion that explains whether a link (nexus) exists between a Veteran's current medical condition and their military service, service-related injury, or exposure, on an at least as likely as not (50% or greater probability) basis. A nexus letter provides medical context but does not determine VA decisions. You can learn more about our medical nexus letter services, including the types of cases we review, on our Services page.
A VA nexus letter is written by a licensed provider who is qualified to evaluate the specific condition being claimed. The provider must give an independent, evidence-based medical opinion using accepted medical standards. The VA weighs opinions based on the provider's qualifications, reasoning, and supporting evidence.
All nexus letters are written by licensed MD physicians with formal training in internal medicine, occupational & environmental medicine, addiction medicine, preventive medicine, and public health. Each case is reviewed individually, and every opinion is based on medical evidence. We do not use templates, automated language, or predetermined conclusions.
Our VA nexus letters are written by licensed MD physicians and are based on comprehensive medical record review, accepted medical standards, and clear medical reasoning. When appropriate, we incorporate peer-reviewed medical research to explain how a condition could reasonably be related to military service or a service-connected condition. Learn more.
Not always. Some nexus letters rely primarily on credentials or templated statements. In more complex VA disability claims - such as secondary service connection, toxic exposure claims, or delayed-onset conditions - medical research can be essential in explaining disease mechanisms and progression.
No. Our physicians provide independent medical opinions, not legal advocacy. We do not guarantee VA disability outcomes. Each nexus letter reflects professional medical judgment based on the available evidence and accepted medical standards. If the medical evidence does not support a nexus, we will explain that clearly and may decline to issue a letter.
No. Ethical medical opinions cannot guarantee VA approval or service connection. We provide independent medical opinions and do not guarantee outcomes. Our role is to provide an objective, medically supported opinion based on the evidence and medical reasoning. More information about our role and scope is outlined in our medical nexus letter services page.
We commonly evaluate:
We provide medical nexus letters for a range of conditions when supported by the medical record and current medical evidence. This includes general medical conditions like sleep apnea and degenerative disease as well as cases involving occupational, environmental, or addiction-related factors. A full description of the types of medical nexus letters we provide is available on our Services page.
Yes. Reviewing medical records is essential for forming a credible VA nexus opinion. This typically includes service treatment records, post-service medical records, diagnostic studies, and other relevant documentation.
To ensure a thorough and timely review, we set reasonable limits on the volume of records reviewed per case. However, some cases require a more extensive review of additional records, and this will be discussed transparently before proceeding.
Complex VA nexus letter cases may require additional review time or may be better addressed by focusing on one condition at a time. We will discuss scope, feasibility, and expectations before starting on your case.
Most VA nexus letters are completed within 2-3 weeks after all required records are received. Timelines depend on the complexity of the case and the completeness of the records. You will be notified if additional information is needed.
Yes. A prior VA denial does not prevent a new medical opinion. In some cases, a nexus letter can help clarify medical issues that were not adequately addressed in earlier decisions.
No. Veterans may request a nexus letter independently or through an attorney. We work with both Veterans and legal representatives.
If the medical evidence does not support a nexus opinion, we will explain why and may decline to issue a nexus letter. This protects the integrity of the medical opinion and avoids unsupported conclusions.
No. Nexus letters are independent medical opinions based on record review and do not involve diagnosis, treatment, or ongoing medical care.
To request a nexus letter, please complete our VA Nexus Letter Intake form. Once submitted, your intake form will be reviewed by a licensed MD physician, and we will follow up with next steps.
Yes. We provide MD physician-authored medical opinions addressing functional limitations and reasonable accommodations for federal disability accommodation requests. You can begin by completing our Federal Disability Accommodations intake form.
For a detailed overview of the types of medical nexus letters we provide,
please visit our Nexus Letter Services page.