VA Nexus Letter and Medical Opinion Request

Thank you for your interest in our nexus letters and medical opinions. Our physicians provide independent, evidence-based medical opinions to help Veterans document potential relationships between medical conditions and military service.

Please complete this form to tell us about your medical condition, military service, and VA disability claim. You may indicate a preferred service level, or our office can help you determine which service may be appropriate.

Submitting this form does not obligate you to purchase a service or guarantee that a medical nexus opinion can be provided. Our office will review your information and contact you regarding the next steps, including instructions for secure records submission when appropriate.

Who is completing this form?* This field is required.

Veteran

Spouse or family member

Attorney or accredited representative

Other individual assisting the Veteran

Please provide your name, relationship to the Veteran, email, phone, and indicate the preferred contact person (you or the Veteran).* This field is required.

0/100

Veteran's full legal name* This field is required.

First Name

Last Name

Veteran's preferred form of addressOptional

Veteran's date of birth* This field is required.

Date

Veteran's email address* This field is required.

example@example.com

Veteran's phone number* This field is required.

Area Code

Phone Number

Veteran's state of residence* This field is required.

If residing outside the United States, please provide your city and country.* This field is required.

Branch(es) of military service* This field is required.

Army

Navy

Air Force

Marine Corps

Coast Guard

Space Force

Other

Dates of military service* This field is required.Please include relevant active-duty, Reserve, or National Guard service dates. Approximate dates are acceptable.

Military occupational specialty (MOS), rating, or AFSC relevant to your claimed condition

Duty stations, ships, or units relevant to your claimed condition

0/100

Deployments relevant to your claimed condition

0/100

For what medical condition are you requesting a nexus opinion?* This field is required.Each nexus opinion generally addresses one claimed medical condition. Closely related conditions may sometimes be evaluated together when medically appropriate.

Has this condition been diagnosed by a licensed medical professional?* This field is required.

Yes

Not sure

When was the condition first diagnosed?* This field is required.Approximate dates are acceptable.

When did you first experience symptoms of this condition?* This field is required.

Were symptoms of this condition present during military service?* This field is required.

Yes

Not sure

Has this condition continued, recurred, or worsened since military service?* This field is required.

Yes

Not sure

Not applicable

Is there anything else about the medical history of this condition that you would like our physician to know?Optional

0/100

How do you believe your condition is related to military service?* This field is required.

Condition or symptoms began during military service

Related to a specific injury, illness, event, or military duty

Related to repetitive physical demands during service

Caused by an already service-connected medical condition

Aggravated by an already service-connected medical condition

Pre-existing condition worsened during military service

Related to toxic or environmental exposures

Not sure — I would like the physician to evaluate the possible relationship

Other

Please briefly describe the circumstances you believe contributed to your condition.* This field is required.Briefly describe the injury, event, duties, medical condition, or other circumstances you believe are relevant. You do not need to use medical or legal terminology.

0/100

Which service-connected condition do you believe caused or aggravated your claimed condition?* This field is required.

Does your claim involve a toxic or environmental exposure?* This field is required.

Yes

Not sure

What types of exposures occurred?* This field is required.Check all that are relevant to your condition.

AFFF/PFAS

Burn pits

Asbestos

Solvents

Fuels

Pesticides

Heavy metals

Radiation

Contaminated water

Chlorine

Herbicides

Radiation

Where, when, and how frequently did the exposures occur?* This field is required.

0/100

Has the VA acknowledged or documented the relevant exposure?* This field is required.

Yes

Not sure

What is the current status of your VA disability claim for this condition?* This field is required.

Not yet filed

Initial claim pending

Previously denied

Supplemental Claim pending or planned

Higher-Level Review pending or planned

Board appeal pending or planned

Already service-connected; seeking an opinion for a related condition

Other / Not sure

Has a VA or contracted examiner previously issued an unfavorable medical opinion about this condition?* This field is required.

Yes

Not sure

Do you have a VA decision letter explaining a prior denial?* This field is required.

Yes

Not sure

If your claim was denied, what reason did the VA provide?A brief summary is sufficient. We may request the actual decision letter at a later date.

0/100

Which records do you currently have available for review?

VA medical records

Private medical records

Service treatment records

Personnel or deployment records

VA decisions

C&P examination reports

Diagnostic studies

Prior nexus opinions

Lay or buddy statements

Other

Approximately how many pages of relevant records do you anticipate submitting?* This field is required.Level 0 includes review of up to 25 pages. Levels 1–3 include review of up to 50 pages. Records beyond these limits incur a fee due to the additional physician time required for review and analysis. Our office can help you identify the most relevant records.

25 pages or fewer

26 - 50 pages

51 - 100 pages

More than 100 pages

Not sure

Which nexus letter service are you interested in?* This field is required.You may select a preferred service level or ask our office for guidance. Your selection does not constitute a purchase or guarantee that the requested service is medically appropriate; in some situations, our physicians may recommend a different level based on the complexity of your case and the available evidence. Please visit our website for details on these levels.

I'm not sure. Please recommend the appropriate service level.

Level 0 - Medical Nexus Feasibility Review

Level 1 - Medical Opinion Letter

Level 2 - Comprehensive Medical Opinion Report

Other

Have you already discussed this request with our office?* This field is required.

Yes - Already discussed a specific level.

Yes - Discussed without selecting a level

No - this is my first contact with your office

Do you have a physician preference?* This field is required.

No preference

Prefer a physician with occupational and environmental medicine expertise

Prefer a physician with addiction medicine expertise

Not sure - please assign the most appropriate physician

Are you interested in a Disability Benefits Questionnaire (DBQ), if available and medically appropriate?* This field is required.Please note that DBQ evaluations are only available for Veterans residing in Washington state, or Veterans who will physically be in Washington state at the time of the DBQ evaluation.

Yes

Not sure

Do you have a specific VA claim or appeal deadline?* This field is required.A limited number of expedited slots are available each week and are subject to physician approval and scheduling availability. Additional fees apply for expedited reports; please visit our website for details.

Yes

Not sure

When is the deadline?* This field is required.

Date

Please review and acknowledge each statement before submitting your request.* This field is required.

I understand that David Medical Services provides independent, evidence-based medical opinions. A favorable medical opinion or approval of VA benefits cannot be guaranteed.

I understand that the physician may determine that a requested opinion is not medically supportable or may recommend a different service level.

I understand that each claimed medical condition generally requires a separate analysis and fee, and that additional records or services may involve additional charges.

I understand that submission of this form does not establish a treating physician–patient relationship or authorize work to begin. Professional services require agreement on scope and fees and payment before work begins.

I certify that the information provided is accurate to the best of my knowledge and that I am the Veteran or am authorized to submit this request on the Veteran's behalf.

How did you learn about us?

AI referral (ChatGPT, Claude, Gemini, etc.)

Internet search

Facebook

Referred by another Veteran

Referred by family member

Other

Please verify that you are human* This field is required.

VA Nexus Letter and Medical Opinion Request