David Medical Services provides physician-authored VA nexus letters and independent medical opinions for Veterans and attorneys seeking well-supported, ethical documentation for VA disability claims.
Every medical 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 detailed review of medical records, service history, and accepted medical principles. We do not use templates or automated reports.
Our nexus letter fees reflect the 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.
A concise, evidence-based nexus letter tailored to your service-connected condition. This includes:
Best for: Veterans with a well-documented condition who need a strong, standalone nexus opinion.
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.
Includes everything in Level 2, plus a 30-minute video 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.
A concise, evidence-based nexus letter tailored to your service-connected condition. This includes:
Best for: Veterans with a well-documented condition who need a strong, standalone nexus opinion.
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.
Includes everything in Level 2, plus a 30-minute video 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.
*One medical condition per nexus letter: Additional conditions require separate review and fees due to the time and research involved.
*Medical record review policy: Our flat fees include physician review of up to 50 pages of documents relevant to the claimed condition. (A “page” refers to one page of a PDF medical record as submitted. Blank cover pages and administrative dividers are not counted.) This allows for careful, thorough medical analysis while keeping nexus letter services clearly scoped and accessible. If additional records are necessary to support the medical nexus opinion, extended record review is available at an additional fee:
Veterans are encouraged to submit the most relevant records—such as service treatment records, key diagnostic reports, and pertinent post-service medical documentation—rather than complete medical files, which may not strengthen the nexus opinion.
*Turnaround time: Most nexus letters are completed within 2 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.
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.