Every independent medical opinion or nexus letter is prepared by licensed MD physicians with experience in internal medicine, occupational & environmental medicine, addiction medicine, preventive medicine, and/or public health, and is based on a comprehensive review of medical records, service history, and accepted medical principles. We do not use templates, pre-written language, or automated reports. Each nexus opinion is individualized to your medical history.
While our fees may be higher than non-MD physician nexus letter services, our opinions are grounded in medical training, clinical experience, and structured medical-legal analysis. Our fees for record review and medical nexus opinion letters reflect the physician time, expertise, and professional responsibility required to produce a defensible medical opinion suitable for VA submission.
The fee structure below is effective 1 January 2026. If you are unsure which level is appropriate for your case, please call us at 888-929-5521 or email admin@davidmed.org. We are happy to guide you prior to payment.
Our services are not limited to initial VA disability claims. Veterans may request an independent medical evaluation for an initial claim, secondary service connection, aggravation, a claim for increased evaluation, or medical issues raised in a prior denial or C&P examination.
The appropriate service level depends on the complexity of the medical question, the records requiring review, and the type of opinion or documentation requested.
For medically complex or uncertain claims, especially those involving toxic exposures, delayed onset, prior denials, or competing risk factors, a physician may need to first determine whether the requested nexus can be medically supported.
Some especially complex cases, including certain toxic-exposure claims, may require review beyond the standard Level 0 scope. When a meaningful assessment requires a substantially larger record set or unusually complex analysis, we will let you know before proceeding if additional review fees are needed.
This service does not include a nexus letter. If the nexus is medically supportable and you proceed with an eligible Level 2 or higher opinion for the same condition, the full Level 0 fee is credited toward that service. Best for: Toxic exposure claims, complex causation questions, prior denials, or cases where medical feasibility should be assessed before a full opinion is prepared.
Supplemental Records Review — $250 per 25 pages
Available following a completed Level 0 Medical Nexus Feasibility Review for review of newly obtained evidence relevant to the issues identified in the original assessment. This service does not include a new written report or revision of the completed Level 0 assessment.
Each Supplemental Records Review fee covers one submission of up to 25 pages. Records should be submitted together; later or additional submissions require a separate review fee.
An evidence-based independent medical opinion / nexus letter tailored to your condition. This includes:
Best for: Veterans who need a clear, medically supported nexus opinion without a formal written record summary.
This includes everything in Level 1, plus:
This tier strengthens the medical and legal clarity of your claim by explicitly documenting what records were considered and how they support the medical opinion.
This is our most commonly selected option. Best for: Prior denials; complex medical histories; or claims requiring stronger supporting analysis.
This level includes everything in Level 2, plus a 30-minute phone consultation with the reviewing physician. This allows you to:
Best for: Complex or contested claims; toxic exposure cases; or Veterans who want the highest level of physician involvement and clarity.
DBQs specifically require a physician examination, clinical documentation, and additional professional responsibility beyond the nexus opinion. DBQ completion is now offered as an optional add-on.
Requirements:
Available for a previously completed opinion when new VA reasoning, a subsequent C&P examination, rating decision, or limited new medical evidence requires a focused supplemental physician opinion. Includes review of the new issue or evidence (up to 25 pages of source documents) and preparation of one signed addendum addressing the same claimed condition and nexus question.
A thorough independent medical opinion requires careful review of relevant medical documentation. Each service level is limited to a maximum number of original source documents. (A "page" refers to one page of a PDF medical record, one photo, or one screenshot as submitted. AI-generated summaries are not accepted as medical documents.) This allows for careful, thorough medical analysis while keeping nexus letter services clearly scoped and accessible.
Because physician review time increases significantly with larger record sets, additional records are billed as follows:
$250 (for additional physician review time) per additional 25-page increment
Most VA files involve 100 - 300+ pages of records. We strongly recommend submitting only documentation relevant for your claimed condition (such as service treatment records, diagnostic reports, specialist evaluations, and key post-service documentation) rather than complete medical files, to avoid unnecessary costs. Submitting focused, relevant records improves the quality and efficiency of your review.
We understand that some Veterans are working within appeal deadlines or time-sensitive claims. For these situations, expedited review may be available on a limited basis depending on physician availability.
Expedited processing allows your case to be prioritized ahead of standard workflow, with a significantly faster turnaround time.
Availability is limited to ensure our reports always meet our standards for quality, and may vary based on current case volume for our physicians.
Expedited Turnaround Options
Expedited cases are prioritized without delaying other Veterans currently in review. To accomplish this, additional physician time is allocated outside of standard scheduling capacity so that every report, expedited or standard, receives the same level of thoroughness, accuracy, and medical integrity.
Rush fees reflect this commitment to:
A limited number of expedited slots are available each week. Please indicate your request at intake or contact us to confirm availability.
*One medical condition per medical opinion / nexus letter: A nexus letter or medical opinion report is not simply a summary of diagnoses. It is a physician’s medical opinion that must clearly explain whether a specific condition is “at least as likely as not” related to military service. To do this properly, each condition requires:
Different conditions often involve different body systems, exposures, timelines, and medical research. Combining multiple conditions into a single letter can make the medical reasoning less clear and less persuasive. For that reason, most nexus opinions are written one condition at a time, allowing each opinion to be:
This approach helps ensure that each condition is evaluated with the level of detail and care it deserves.
*Turnaround time: Most medical opinions and nexus letter reports are completed within 2-3 weeks of intake, payment, and receipt of all records to be reviewed. Some complex cases may require additional time; if longer time is required, the Veteran will be notified as soon as possible.
*Prepayment is required: Work begins after intake, payment, and records are received.
*Fees are non-refundable once work has begun, as significant physician time is dedicated to records review, research, and analysis.
*Disability Benefits Questionnaires (DBQs) may be completed via secure telehealth when clinically appropriate and supported by the medical records. However, certain DBQs require in-person examination or specialized testing and cannot be completed via telehealth. Completion of any DBQ is at the physician's discretion.
*Nexus letters, medical opinion reports, and DBQ form completions involve independent medical opinions and do not establish a treating physician-patient relationship.
*Medical opinions and nexus letter reviews are independent medical evaluations. Approval of a VA claim cannot be guaranteed, as final adjudication rests with the VA.
Veterans sometimes ask us why nexus letter fees vary so widely among providers. The difference often comes down to who is reviewing your records and how the opinion is prepared.
A nexus opinion is not just a letter. It is a medical-legal document that must:
At David Medical Services, every opinion is:
Lower-cost services may rely on standardized wording, minimal review, or non-physician authorship.
While those options may be appropriate for some Veterans, they are not equivalent to a comprehensive physician evaluation.
Our goal is not to be the lowest-cost provider. Our goal is to provide medically sound, ethically defensible opinions that reflect the time and expertise required.
When evaluating cost, we encourage Veterans to consider:
Quality medical analysis requires time and professional training. Our fees reflect that commitment.
All nexus letters and medical opinion reports are authored by a licensed medical physician with extensive clinical training. Each opinion is based on a careful review of the medical record, accepted medical literature, and a clear, defensible rationale.
We do not guarantee outcomes or write predetermined conclusions. Our role is to provide an honest, well-reasoned medical opinion that can withstand VA review and legal scrutiny.
Unlike mass-produced nexus letters, our work is individualized. When included, medical record summaries are physician-written and designed to clarify - not inflate - the evidentiary record.
Our fee structure reflects the time, expertise, and level of analysis involved in each service tier. You choose the level of involvement that best fits your needs - with no hidden fees or pressure to upgrade.
We routinely address multifactorial conditions, toxic and occupational exposures, secondary service connections, and functional limitations - cases that require nuance, not boilerplate language.
If your case involves military records correction, ABCMR/BCNR review, or medical retirement, a standard nexus letter may not be sufficient.