Services /VA nexus letters & DBQs

Veterans' disability evaluations

VA nexus letters & DBQs, written by a psychiatrist

Your claim needs more than a diagnosis — it needs a reasoned medical opinion on whether your condition is at least as likely as not connected to your service. We review your records, complete a full clinical interview, and write the nexus letter or DBQ with the rationale the VA actually weighs.

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Physician-written, independent opinions Telehealth for veterans in 10 states

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What we provide

Evidence built for your claim

Under 38 CFR §3.159, competent medical evidence has to come from a qualified provider — and in practice the VA weighs an opinion by the strength of its reasoning, not the sentence at the end. Everything we produce is built accordingly: records reviewed and cited, DSM-5-TR diagnosis, symptom timeline, functional impact, and an explicit rationale for the conclusion.

Nexus letters

An independent psychiatric opinion on whether your condition is at least as likely as not connected to service — direct, secondary, or by aggravation — with the clinical reasoning spelled out step by step.

Completed DBQs

Disability Benefits Questionnaires for mental health conditions, completed and signed from a full clinical interview and records review — individualized, never templated, the version that survives VA scrutiny.

Second opinions & appeals

After a denial, or after a C&P exam that recorded a conclusion with little rationale — an independent review of what the record actually supports, and a reasoned opinion where it supports one.

How it works

From your records to a defensible opinion

STEP 01

Your records and the question

Send your service treatment records, VA decision letters, any prior C&P exam, and current treatment records, plus the DBQ form for your condition if you have it. We review before the interview, not after — the opinion is only as strong as the record behind it.

STEP 02

The evaluation

A comprehensive clinical interview by secure video: symptom history and timeline, stressor documentation, current functioning, and a DSM-5-TR diagnostic assessment where clinically indicated.

STEP 03

The opinion and paperwork

A nexus letter with explicit rationale, a completed and signed DBQ, or both — written to the VA's evidentiary standards and delivered to you and your representative, ready to submit with your claim or appeal.

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Who it's for

Who we work with

Veterans filing an initial disability claim who need an independent medical opinion

Veterans appealing a denial, or responding to an unfavorable C&P exam

Secondary-condition claims — depression or anxiety arising from a service-connected condition such as chronic pain, tinnitus, or TBI

PTSD claims involving combat and non-combat stressors, military sexual trauma, or delayed onset

Veterans who need a current DBQ completed for a mental health condition

VSOs, accredited claims agents, and attorneys who need an independent psychiatric evaluator

Veterans in the ten states where our clinicians are licensed, by secure telehealth

Full scope

Every opinion type we provide

A VA claim turns on a medical opinion about origin, not just a diagnosis: whether a condition is at least as likely as not related to military service — a 50 percent or greater probability. Under 38 CFR §3.159 that opinion has to come from a qualified provider, and in practice the VA weighs it by the strength of its reasoning rather than its conclusion. So these evaluations are built to carry that reasoning: the records reviewed, the diagnosis under DSM-5-TR criteria, the symptom timeline, the functional impact, and an explicit rationale for the opinion reached.

We provide

Nexus letters — an independent psychiatric opinion on whether a condition is at least as likely as not connected to service, with the clinical rationale spelled out
Disability Benefits Questionnaires (DBQs) for mental health conditions, completed and signed from a full interview and records review
Direct service connection opinions, where the condition began or was documented during service
Secondary service connection opinions — depression or anxiety arising from an already service-connected condition such as chronic pain, tinnitus, or TBI — with the step-wise clinical progression explained
Aggravation opinions, where service worsened a condition that pre-dated it
PTSD opinions covering combat and non-combat stressors, military sexual trauma, and delayed-onset presentations
Second opinions after a denial, or after a C&P exam that recorded a conclusion without much rationale

We produce medical evidence; the VA decides the claim. A well-reasoned opinion can meaningfully strengthen a claim or an appeal, but no evaluation can guarantee a service connection or a rating percentage — and if the records don't support a defensible opinion, we'll tell you that rather than write one we can't stand behind. This is an independent evaluation you submit as evidence, not a VA Compensation & Pension (C&P) exam, and nothing here is legal advice. Available to veterans in the ten states where our clinicians are licensed.

These are not treatment relationships

The goal is objective assessment and documentation that supports your claim with evidence the VA can weigh. An evaluation doesn't establish ongoing psychiatric care — and if treatment is indicated, we say so, and can discuss it with you separately. Nothing on this page is legal advice; for claim strategy, work with your VSO, claims agent, or attorney.

Cost

What a nexus letter or DBQ costs

There's no flat rate, because no two claims take the same amount of work. Each case is quoted individually before you commit, and the quote comes down to four things:

The nature of the evaluation

Direct, secondary, or aggravation opinion; nexus letter, DBQ, or both — and the evidentiary standard each has to meet.

Background evidence

How much record there is to review — service treatment records, VA decisions, prior C&P exams, and treatment history.

Collateral interviews

How many additional people need to be interviewed — a spouse, a battle buddy — to document what the record alone can't.

Report length & paperwork

How long the opinion has to run, and whether a DBQ or other forms are completed alongside it.

The free first step is the honest read: if your records don't support a defensible opinion, we tell you that before you've paid for a full evaluation.

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Getting started

Veterans and representatives both welcome

You can contact us directly, or your VSO, claims agent, or attorney can refer you. Either way, the records drive everything — the more complete the file, the stronger and faster the opinion.

Not sure whether your claim is one we can help with? Ask. We'll give you a straight answer, and if the records don't support an opinion we can defend, we'll say so up front.

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What to send in advance

Service treatment records and your DD-214
VA rating decisions, denial letters, and any prior C&P exam reports
Current mental health treatment records
The DBQ form for your condition, your deadline, and your representative's contact

Don't have everything? Send what you have — we'll tell you what the opinion actually turns on.

Billing

How billing works

Nexus letters and DBQs are private-pay — they're legal-medical evidence for your claim, not treatment, so they aren't billable to health insurance and the VA doesn't pay for them. The evaluation is billed at an hourly rate quoted up front, based on the scope of your claim and records. And it starts with an honest read: if your records don't support a defensible opinion, we tell you before you've spent money on a full evaluation. If treatment is what you need, that's separate — we're in-network with major insurers for ongoing psychiatry and therapy.

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FAQ

Common questions about VA nexus letters & DBQs

What is a nexus letter, and what does "at least as likely as not" mean?

A nexus letter is a written medical opinion on whether a condition is connected to military service. "At least as likely as not" is the VA's threshold — a 50 percent or greater probability, which means the opinion doesn't have to be certain, it has to be reasoned. That's the part that matters: 38 CFR §3.159 requires competent medical evidence from a qualified provider, and the VA gives an opinion weight based on the reasoning behind it, not the sentence at the end. So the letter we write documents the records reviewed, the diagnosis under DSM-5-TR criteria, the symptom timeline, the functional impact, and why the conclusion follows from all of it.

Can you complete my DBQ?

Yes, for mental health conditions. Download the current Disability Benefits Questionnaire for your condition from the VA and send it with your records, and we complete and sign it from a full clinical interview and a review of what you've sent. One thing worth knowing: the VA screens privately completed DBQs and gives less weight to forms that look templated, are unsigned, or come from a provider with no evident relationship to the veteran. An individualized form backed by an actual evaluation and a supporting written opinion is the version that holds up.

Will a nexus letter get my VA claim approved?

No one can promise that, and you should be skeptical of anyone who does. We produce medical evidence; the VA decides the claim, weighing our opinion alongside your service records, treatment history, and any exam it orders. A thorough, well-reasoned opinion can meaningfully strengthen a claim or an appeal — particularly where a prior denial cited a missing service connection, or a C&P exam recorded a conclusion with little rationale. If your records don't support an opinion we can defend, we'll say so up front rather than write one that won't survive review.

Is this the same as a C&P exam?

No. A Compensation & Pension exam is ordered and paid for by the VA, performed by a VA or VA-contracted examiner, and you don't choose who does it. What we provide is independent medical evidence — an evaluation you commission, from a psychiatrist you choose, submitted to the record on your side of the claim. A strong independent opinion is often exactly what's needed when a C&P exam was brief or recorded a conclusion without much rationale.

What records should I send?

Your service treatment records, VA rating decisions and denial letters, any prior C&P exam reports, current mental health treatment records, and the DBQ form for your condition if your claim needs one completed. Don't have everything? Send what you have — your VSO or representative can help you request the rest, and we'll tell you what the opinion actually turns on.

Start your nexus letter or DBQ

Send your records and the DBQ form for your condition, and we'll give you an honest read on what the record supports — with a quote and timeline before you commit.

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