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 mecnexus letter fees reflect the physician time, expertise, and professional responsibility required to produce a defensible medical opinion suitable for VA submission.
Every medical nexus opinion 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.
An evidence-based medical nexus opinion tailored to your service-connected condition. This includes:
Best for: Veterans who need a strong, medically supported nexus opinion without formal record summary.
Nexus Letter + Medical Records Summary
Everything in Level 1, plus:
This tier improves legal defensibility by documenting what records were considered and how they support the medical opinion.
Best for: Prior denials; complex medical histories; claims requiring stronger supporting analysis. This is our most commonly selected option.
Includes everything in Level 2, plus a 30-minute virtual consultation with the reviewing physician. This allows you to:
Best for: Complex histories; contested claims; cases where direct physician discussion adds clarity or strength; those seeking high-level support.
Because 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 rather than included in Level 3 nexus letter service. Must be paired with Level 3, and Veteran must be physically in Washington State at the time of the telehealth visit.
Please also submit our Telehealth Consent for DBQ Evaluation Form.
If you are unsure which level is appropriate for your case, we are happy to guide you prior to payment.
A thorough nexus opinion requires careful review of relevant medical documentation.
Each service level includes review of up to 50 pages of records. (A "page" refers to one page of a PDF medical record as submitted.) 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 to the claimed condition (such as service treatment records, key diagnostic reports, and pertinent post-service documentation) rather than complete medical files, to avoid unnecessary costs.
*One medical condition per nexus letter: Additional conditions require separate review and fees due to the time and research involved.
*Turnaround time: Most nexus letters 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 and DBQ form completions involve independent medical opinions and do not establish a treating physician-patient relationship.
*Nexus opinions 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 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.