Who This Service Is For

This service may be appropriate for Veterans who:

• Are pursuing an initial VA mental health claim, supplemental claim, or appeal
• Have documentation of mental health symptoms during service, after service, or both
• Are seeking an objective clinical opinion grounded in evidence and psychiatric standards
• Understand that a nexus letter is not legal representation and does not guarantee an outcome

This service may not be appropriate when records are minimal, timelines are unclear, or the available medical evidence does not support a service connection. In such cases, limitations are explained clearly and alternative next steps may be recommended.

Clinical Scope and Limitations of a Nexus Letter

A nexus letter is a medical opinion written by a licensed clinician. When supported by evidence, it connects three essential elements:

• A current psychiatric diagnosis
• A credible timeline of symptom onset and progression
• A medically reasoned link between the condition and military service, or between a service-connected condition and a secondary mental health condition

A nexus letter is not:

• A guarantee of VA approval or a specific disability rating
• A legal argument or a substitute for an attorney, VSO, or accredited claims agent
• A document written to match a desired outcome rather than the clinical evidence

The role of VerisMind is to provide an accurate, objective medical opinion based on documentation and clinical judgment.

What Your Nexus Letter May Include

When clinically supported, a nexus letter may include:

• Summary of relevant service treatment records and military history as it relates to the claim
• Review and synthesis of VA records, civilian medical records, and prior mental health evaluations
• Diagnostic rationale using DSM criteria, including differential considerations when appropriate
• Discussion of symptom onset, chronicity, and course over time
• Functional impairment analysis with real-world examples when supported by the record
• Medical opinion language using VA standards, such as at least as likely as not, when appropriate
• Citation of relevant medical literature or clinical guidelines when applicable

Letters are individualized. Generic templates are not used as a substitute for case-specific analysis.

Conditions Commonly Addressed

Nexus opinions may be considered for conditions including, but not limited to:

• Post-traumatic stress disorder and trauma-related disorders
• Major depressive disorder and persistent depressive symptoms
• Anxiety disorders, including generalized anxiety and panic disorder
• Sleep disturbance and nightmares when linked to trauma or service-related conditions
• Adjustment disorders when clinically appropriate and supported by documentation
• Secondary mental health conditions associated with service-connected injury, chronic pain, or medical illness

Each request is evaluated individually. Not every clinical presentation supports a nexus opinion.

Records Required

A defensible nexus opinion requires adequate documentation. Veterans are responsible for providing relevant records. Commonly requested records include:

• Service treatment records and relevant personnel records when available
• VA problem lists, mental health notes, and medication history
• Prior psychiatric evaluations, therapy summaries, or hospital records
• Compensation and Pension examination reports and prior VA decision letters
• Civilian medical records relevant to the condition or timeline
• Line-of-duty documentation, incident reports, or treatment summaries related to the claimed stressor

If records are incomplete, the opinion may be limited, or additional documentation may be recommended prior to proceeding.

Medical Record Review and Fees

All Veterans Nexus letter requests begin with a medical record review and investigative assessment. This initial step allows determination of whether sufficient documentation exists to support an independent medical opinion and to estimate the scope of work required.

The medical record review and investigative assessment fee is $300. This fee covers a limited clinical review focused on record sufficiency, timeline clarity, diagnostic plausibility, and identification of any gaps that may affect the ability to render a defensible nexus opinion. This fee is non-refundable. If the case proceeds, the $300 screening fee is applied toward the total cost of the nexus letter.

Following completion of the medical record review and investigative assessment, Veterans are provided with a written fee estimate based on the level of complexity involved.

Nexus Letter Fee Levels

Medical Record Review and Investigative Assessment – $300

Level 1 – $700 (minus screening credit)
Appropriate for cases with limited record volume, a clear timeline of symptom onset, and straightforward clinical questions. These cases typically involve a single primary diagnosis with documentation that reasonably supports review and opinion formation.

Level 2 – $1,000 (minus screening credit)
Appropriate for cases with moderate record volume, multiple relevant records across time, or added clinical complexity. These cases may involve diagnostic clarification, overlapping conditions, or secondary mental health considerations that require additional analysis.

Level 3 – $1,300 (minus screening credit)
Appropriate for cases with extensive records, complex timelines, secondary or comorbid conditions, or higher-acuity presentations. These cases require more extensive review, synthesis, and clinical reasoning to produce a defensible medical opinion.

Fee level determinations are based on record volume, complexity of the clinical question, need for diagnostic clarification, and the clinical time required for review, interview when indicated, and letter preparation. Fees are based on clinical work performed and are not related to claim outcomes or disability ratings.

No work beyond the initial medical record review and investigative assessment begins until scope, timeline, and fees are clearly agreed upon.

The Process

Step 1: Consultation Request
To begin, click Request a Medical Record Review and Investigative Assessment or visit the Contact page to submit your request.

Step 2: Medical Record Review and Investigative Assessment
Available documentation is reviewed at a limited, high-level to assess record sufficiency, timeline clarity, and diagnostic plausibility. This step is completed after receipt of the $300 medical record review and investigative assessment fee and does not include a nexus opinion.

Step 3: Consent, Scope, and Fee Determination
Following the investigative assessment, informed consent and a professional services agreement are provided outlining scope of work, fee level, timelines, and limitations. No further work proceeds until these terms are accepted.

Step 4: Comprehensive Records Review and Clinical Interview
A comprehensive medical record review is completed. A clinical interview is conducted when indicated to clarify symptom history, timeline, and functional impact.

Step 5: Nexus Letter Completion and Delivery
The nexus letter is finalized and delivered according to the service agreement. If the evidence does not support a nexus opinion, the rationale is explained and alternative next steps are provided.

Ethical Standards and Limitations

To maintain clinical integrity and ethical compliance:

• Claim approval or specific disability ratings cannot be guaranteed
• Medical opinions are based on evidence and clinical reasoning, not requested outcomes
• Requests may be declined if documentation does not support a defensible opinion
• Nexus services are independent medical opinions and are separate from treatmentFees and Payment

Nexus letter services are self pay and are not billed to insurance. Fees are based on record volume, complexity, and required clinical time. You will receive fee information prior to initiation of services and no work begins until the scope and payment terms are clearly agreed upon.

Crisis and Clinical Care Disclaimer

This service does not provide crisis intervention and does not replace ongoing psychiatric treatment. Veterans experiencing suicidal thoughts, inability to remain safe, or immediate danger should call 988 and press 1 for the Veterans Crisis Line, call 911, or go to the nearest emergency department.

Request a Nexus Letter Consultation

To request a consultation, complete the intake form. You will be contacted with next steps for records submission and screening.

Frequently Asked Questions

Do I need to be an established patient?
No. Nexus letter services are provided as independent medical opinions and do not require ongoing treatment.

Can approval or a specific rating be guaranteed?
No. The VA determines service connection and ratings.

Can a nexus letter be written without records?
Adequate documentation is required to render a defensible medical opinion.

Will the letter be written to meet VA expectations?
The opinion reflects clinical evidence and judgment. Conclusions cannot be predetermined.

How long does the process take?
Timelines vary based on record volume and complexity and are discussed after records screening.