Questions, answered plainly
Frequently asked questions.
What a nexus letter is, what it costs, who signs it, and what we will not do. Written for veterans and for the engines that quote us.
- What is a VA nexus letter?
- A nexus letter is a written medical opinion that answers whether a veteran’s current condition is connected to military service. The VA standard is “at least as likely as not,” meaning 50 percent or greater. Line of Duty Medical writes these as independent medical opinions after a physician reviews the complete claims file.
- How much does a nexus letter cost?
- All-in, a single-connection nexus at Line of Duty Medical is $1,250. Each additional connection is $400. That is a $350 records review, a $1,250 opinion, and $350 of the review credited if you proceed. National prices in 2026 typically run $500 to $2,000 depending on credentials and whether the review is credited.
- What is a DBQ, and when do I need one?
- A Disability Benefits Questionnaire is the VA’s own exam form. It is used to rate severity after service connection is already established, or to counter a weak C&P exam. We complete DBQs at $500 from your records, or $900 with an in-person examination in Evans, Georgia.
- Is an independent medical opinion the same as a nexus letter?
- Yes, in VA practice the two terms describe the same work: a physician’s reasoned opinion on service connection. “Nexus letter” is the common veteran phrase. “Independent medical opinion” or IMO is the formal name. We use both. The document is not a form letter. It cites your records and the medical literature that supports the connection.
- Who writes and signs the opinion?
- A licensed clinician whose training fits your condition. Nexus opinions are signed by a physician, MD or DO. DBQs are completed by a physician, physician assistant or nurse practitioner, within the scope their license allows. Every signer is named on the document and personally reviews your complete file before signing. We do not use anonymous panels.
- Why does a physician-signed letter cost more than one from a PA or NP?
- Many national shops price $500–$800 letters written by physician assistants or nurse practitioners, often from home or while on duty at a military treatment facility. Those letters can be accepted. VA raters weigh credentials and rationale together. A physician-signed opinion with page-level citations is the product veterans buy when the claim is contested, on appeal, or already denied.
- Is the $350 records review credited if I move forward?
- Yes. If your claim continues after the written assessment, $350 of the $350 review is credited against the nexus opinion or DBQ. If we tell you in writing that the record cannot support the claim, you have spent $350 and we stop there.
- What does a DIC cause-of-death opinion decide?
- VA pays Dependency and Indemnity Compensation when a service-connected condition was the principal cause of a veteran's death or contributed substantially or materially to it, under 38 CFR 3.312. The opinion is a physician's answer to that question, reasoned from the veteran's records and the records of the death. VA decides the claim.
- The death certificate does not name the service-connected condition. Is that the end of it?
- Not always. A death certificate records the immediate and underlying causes and is not a finding that nothing else contributed. Whether another condition contributed is a medical question the records answer or do not. The review tells you which, in writing, before any opinion is bought.
- Who can request a DIC opinion?
- A surviving spouse, child or parent who is claiming, or someone helping them. A person acting for the claimant tells us what lets them do so, such as a power of attorney. We are a medical practice: we prepare the opinion, and a VA-accredited representative can file and argue the claim.
- What if you cannot support my claim?
- We tell you in writing and stop. The records review fee pays for that answer in either direction. We never write an opinion the record cannot carry, and we never take a percentage of back pay.
- How long does a nexus letter take?
- It depends on the records and on how many conditions the opinion covers, so we do not promise a date. We will be in touch as soon as we can at every step.
- Can I pay over time?
- Yes. After the records review, the balance can be split in half 30 days apart, or into three equal monthly card payments, at no extra cost. Each stage of the work is completed and released once payments cover it. We do not work on credit, and no fee is contingent on the claim outcome.
- Do you only serve Georgia veterans?
- No. Record review and nexus opinions are written for veterans nationwide. The practice is based in Evans, Georgia, near Augusta and Fort Eisenhower. In-person DBQ examinations are performed locally. Veterans outside the CSRA use the records-based path.
- Do I need a lawyer to file a VA claim?
- No. You can file on your own, and many veterans do. If you want help, it depends on the stage. Before VA decides your claim, a VSO or county service officer files it for free, and under 38 U.S.C. 5904(c)(1) an accredited attorney or agent may not charge a fee on an initial claim anyway. After a denial, a VA-accredited attorney or claims agent can take the appeal, usually for a share of past-due benefits rather than money up front. A VSO is appointed with VA Form 21-22, an attorney or agent with VA Form 21-22a. An independent medical opinion is evidence you submit with the claim, so you can obtain one whether you are unrepresented, VSO-represented, or attorney-represented.
- Do you file my VA claim or represent me?
- No. Federal law (38 U.S.C. 5901 and 5904) allows only VA-accredited attorneys, agents, and service organizations to charge for preparing or prosecuting a VA claim. We are physicians. Our fees are for medical services: record review, examinations, and written opinions. For filing help, use an accredited representative or a VSO.
- Do I need a nexus letter for sleep apnea?
- Often yes when sleep apnea is claimed as secondary. The VA wants a medical chain from an already-service-connected condition to the apnea. An independent medical opinion can write that chain from the complete file. We do not diagnose apnea from a website form and we do not promise a rating.
- Can you complete a tinnitus or hearing-loss DBQ?
- No. VA publishes no public hearing-loss or tinnitus DBQ. That examination must be performed by a state-licensed audiologist. An independent medical opinion on connection may still be possible when the record supports it.
- Will the VA pay for my nexus letter?
- Almost never. The VA does not reimburse private nexus letters. Veterans pay before any award exists. That is why we lead with a flat review instead of asking for the full opinion fee before anyone has read the file.
Still deciding whether to spend the review?
Send a request. We confirm scope and cost before any work begins.