Our Physician-Authored VA Nexus Opinion Process

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At David Medical Services, every VA nexus letter is personally authored and signed by a licensed MD physician. We do not outsource medical opinions, rely on templates, or use pre-written language. 

Each medical nexus opinion is developed through individualized analysis of your documented medical and service records, applying established medical principles and, when appropriate, peer-reviewed literature.

If you are unfamiliar with the role of a nexus letter in a VA disability claim, you may first wish to review our explanation of What is a VA Nexus Letter?

Our role is to provide an independent, evidence-based medical opinion. We do not guarantee claim approval, and our conclusions are not contingent upon VA outcomes. 

All medical nexus opinions are authored and signed by a licensed MD physician.

Our lead reviewing physician completed residency training in Internal Medicine and fellowship training in Occupational & Environmental Medicine, with additional training in toxicology and complex medical causation analysis. Our additional reviewing physician is trained in General Surgery and General Preventive Medicine & Public Health, and has additional specialty training in Addiction Medicine. Both of our nexus letter physicians have many years of providing primary care services to patients in a variety of clinical settings. 

Our physicians possess current licenses and are in good standing in the State of Washington. Licensure status may be independently verified through the Washington Medical Commission.

Our physicians personally review all records submitted, which may include:

• Service treatment records 
• Post-service medical records 
• VA examinations 
• Diagnostic imaging and laboratory results 
• Specialist evaluations 
• Exposure documentation (including burn pit, toxic exposure, or occupational hazards) 

The medical nexus opinion is based solely on documented evidence and established medical reasoning.

A strong VA nexus letter must clearly connect three elements:

1. A current medical diagnosis, 
2. A documented in-service event, injury, or exposure, and
3. A medically supported connection between the two. 

A strong nexus letter must clearly address the legal framework used in VA claims. You can read more about this in our guide to How Secondary Service Connection Works. 

Each nexus opinion we prepare includes:

• Identification of records reviewed 
• Confirmation of diagnosis 
• Medical analysis of causation or aggravation 
• Discussion of alternative causes when appropriate 
• Citation of peer-reviewed literature when applicable 
• A clearly stated conclusion using VA evidentiary standards (e.g., “at least as likely as not”)
   

Our role is to provide a medically sound, evidence-based opinion. Final adjudication rests with the Department of Veterans Affairs.

We maintain strict professional standards. 

We do not:

• Guarantee VA claim approval 
• Alter medical conclusions to satisfy adjudicative preferences 
• Provide opinions unsupported by the medical record
   

All conclusions are based on clinical judgment and documented evidence.

We offer structured service options based on the complexity of your case: 

Level 1 – Medical Nexus Opinion
Comprehensive physician record review and written nexus opinion.

Level 2 – Nexus Opinion + Medical Records Summary
Includes a structured written summary of relevant medical records.

Level 3 – Nexus Opinion + Records Summary + Physician Consultation
Includes a 30-minute video consultation with the physician.

Turnaround times vary based on record volume and case complexity, but most nexus letters are generally completed within two to three weeks after receipt of all records and payment.

If the VA requests clarification of wording or medical rationale, we will review the request to determine whether a clarification addendum is medically appropriate.

If a VA decision challenges the opinion with specific medical reasoning, we can review the decision and determine whether further medical commentary is warranted.

Many VA claim denials occur not because a condition is not real, but because the medical connection is not clearly explained. We discuss this further in Why VA Claims Get Denied Even When the Condition Is Real.  

If you are considering a MD physician-authored medical nexus opinion, you may begin the intake process here.