$100 off during our launch period — $400 flat rate instead of $500. Fully online. No letter, no charge. Our team reviews your medical records and delivers a physician-signed nexus letter for your VA disability claim.
Start Your RequestMost letters completed within two weeks. Four-week guarantee.
Select your condition, answer a few targeted questions, upload your records, and pay the $50 record review fee. Takes about 10 minutes.
A board-certified physician personally reviews every record you submit and determines whether a supportive nexus opinion can be provided.
If supportable, you pay $350 and receive a signed nexus letter via email. If not, you are not charged the letter fee — and you receive a clear explanation with guidance on next steps.
Most nexus letter services charge between $750 and $1,500. Some charge more. A few charge less. We think $500 (currently $400 during our launch) is the right number.
A good nexus letter takes real work. Your records have to be read cover to cover. The medical reasoning has to be built from scratch, specific to your case, with citations to peer-reviewed literature. A board-certified physician has to review every word before signing. That process takes hours, not minutes. Services charging $150 are cutting corners somewhere: a template with your name dropped in, a non-physician signer, or an opinion so generic that a VA rater sees through it immediately.
At the same time, a veteran shouldn't need to spend $1,200 on a single letter. When a physician writes these opinions consistently and builds efficient systems for record review, the process gets faster without getting worse. That's what lets us charge a fair rate. We're not subsidizing overhead from telehealth platforms, video consultations, or large staff. We review records. We write letters. We do it well, and we do it at a price that doesn't punish you for pursuing the benefits you earned.
Every letter is reviewed and signed by a physician board-certified in a primary care specialty that covers every condition we write letters for — nothing is out of scope. This matters when your letter is weighed against a C&P examiner's opinion.
No templates. No fill-in-the-blank. Every letter is written from scratch based on your specific records, with condition-specific medical reasoning and citations to peer-reviewed literature. VA raters can spot a template — ours aren't.
If your evidence doesn't support a nexus opinion at the 50% threshold, we tell you why and don't charge you. You'll never get a weak letter from us just because we wanted the fee. That protects you from filing a claim with bad evidence.
$400 during our launch period — $100 off our regular $500 rate. Same price for a straightforward tinnitus letter and a complex secondary sleep apnea case. No complexity surcharges, no "expedite" fees, no upsells. You know the cost before you start.
Most letters completed in two weeks. Guaranteed in four. Many services take six to eight weeks with no guarantee. We respect your timeline — especially if you have a claim deadline or a C&P exam approaching.
Rejections come with a real explanation — what was missing, what would strengthen a future request, and what other options exist. That guidance alone is often worth more than a bad letter you paid full price for somewhere else.
A nexus letter is an independent medical opinion from a physician stating that your current medical condition is "at least as likely as not" connected to your military service. The VA uses nexus letters as evidence when deciding disability claims. A strong nexus letter explains the medical reasoning behind the connection and is supported by your records.
Not always. If your condition qualifies for presumptive service connection (for example, under the PACT Act for toxic exposure or burn pit conditions), the VA may grant your claim without one. Your Veterans Service Organization (VSO) can help determine whether a nexus letter would strengthen your claim. For most non-presumptive direct and secondary claims, a nexus letter significantly improves your chances of approval.
A board-certified physician in Family Medicine or Internal Medicine with an active, unrestricted medical license reviews every record and personally signs every letter. This is not a template factory — each letter is individually drafted based on your specific records and medical history. Our team has no treatment relationship with you, which is what makes this an independent medical opinion.
No. The VA accepts medical opinions based on thorough record review. This methodology is consistent with standard medical practice for rendering expert opinions and is supported by established case law (Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 2008). An in-person or telehealth examination is not required.
Our standard turnaround is two weeks from the date we receive your complete records. We guarantee delivery within four weeks. If we are unable to deliver your letter within four weeks, you will receive a full refund.
If after reviewing your records our team determines that a supportive nexus opinion cannot honestly be provided, you are not charged the $350 letter fee. You will receive a written explanation of why we could not support the claim and, where possible, specific guidance on what additional documentation or steps might strengthen a future request.
At minimum: your DD-214 and documentation of your current diagnosis (specialist report, imaging, sleep study, or doctor's note with the diagnosis). For secondary claims, you also need your VA rating decision showing the primary condition is service-connected. Service treatment records and buddy statements are helpful but not always required. Our intake form will guide you through exactly what to upload based on your specific condition.
Yes. We write nexus letters for direct, secondary, and aggravation claims. For secondary claims, the primary condition must be service-connected (or have a pending claim). If your primary condition is pending, we can still proceed, but be aware that if the VA denies the primary condition, the secondary nexus letter may not be usable.
The PACT Act established presumptive service connection for certain conditions related to burn pit exposure, toxic exposure, and Gulf War service. If your condition may qualify, our intake form will flag this and advise you that a nexus letter may not be necessary. We recommend checking with your VSO before paying for a nexus letter for a potentially presumptive condition. If you still need one — for example, if a presumptive claim was denied — we are happy to help.
Yes. If your claim was previously denied, a well-written nexus letter addressing the specific reasons for denial can be submitted as new evidence with a supplemental claim. Include the VA's denial letter when you submit — this helps us understand exactly what the VA found insufficient and write a letter that directly addresses those points.
Erectile dysfunction is typically rated at 0% by the VA, but if service-connected, you may qualify for Special Monthly Compensation (SMC-K) — an additional $139.87 per month for loss of use of a creative organ, added on top of your existing disability compensation. ED is commonly claimed as secondary to medications for PTSD, hypertension, or depression. A nexus letter connecting ED to your service-connected condition or its medications is usually required.
No. This is an entirely online service. You submit your records through our secure intake form, our team reviews them independently, and your completed letter is delivered via email. No phone consultations, video visits, or appointments are offered or available.
No. We provide independent nexus opinion letters only. We do not complete Disability Benefits Questionnaires, perform examinations, or fill out VA forms. If you need a DBQ completed, your treating physician or a VA Compensation & Pension examiner can provide one.
Yes. Your records are submitted through a HIPAA-compliant intake platform with encrypted file storage. Your signed letter is delivered via secure, HIPAA-compliant email. We do not share your information with any third party. Your records are retained only for the duration of your case and deleted upon completion.
Yes — any licensed physician can write a nexus letter, and the VA will accept it. If your doctor is willing and knowledgeable about the process, that's a great option. However, there are a few things worth knowing. Most primary care physicians are not familiar with nexus letters — they aren't taught in medical school or residency, and the specific structure, legal standard of proof, and VA expectations are not common knowledge in clinical practice. A letter that says "I believe this is related to service" without citing specific records, explaining the medical mechanism, or referencing peer-reviewed literature will receive low probative weight from the VA and can be outweighed by a C&P examiner's opinion. Writing a thorough nexus letter also takes hours of record review and research, and there is no billing code, RVU credit, or insurance reimbursement for that work — so many physicians who want to help simply can't justify the time. If your doctor is willing to write one, we'd encourage them to include the specific "at least as likely as not" standard, cite your records by name and date, and support the opinion with medical literature.
A few important ways. Every letter is reviewed and signed by a physician who is board-certified in a primary care specialty whose scope of practice covers every condition we write letters for — nothing is outside our lane. Some services use nurse practitioners, physician assistants, or providers whose specialty doesn't align with the condition being evaluated, which can reduce the probative weight of the opinion if it's challenged. Our letters are individually drafted from your records — not templates with your name swapped in. We operate on a flat-rate model with no complexity surcharges, and our standard turnaround is two weeks when many services take six to eight. We also run every case through a viability review before writing — if the evidence doesn't support a nexus opinion, we tell you why and don't charge you the letter fee. That means when we do write a letter, it's because we genuinely believe the evidence supports it.
If after reviewing your letter you believe something important was not addressed or a factual detail needs correction, let us know and we will revise it at no additional charge. Our goal is to deliver a letter you are confident submitting. Revisions for factual corrections and for incorporating information that was available in the original records are included in your letter fee.
Yes. If you are working with a Veterans Service Organization or a veterans' disability attorney, we are happy to work alongside them. If your representative has specific guidance on what the letter should address — for example, language from a prior denial or particular arguments to cover — include that information when you submit your intake request. We will review and incorporate relevant recommendations into the opinion. All communication is handled through the veteran directly, not between our team and your representative.
Submit it as evidence with your VA disability claim. If you are filing a new claim or a supplemental claim, you can upload the letter directly through VA.gov or submit it by mail using VA Form 20-10208 as a coversheet. If you are working with a VSO or attorney, provide them with a copy and they can submit it on your behalf. Keep a copy for your personal records. The letter becomes part of your claims file and will be reviewed by the VA rating official alongside all other evidence in your case.
Flat Rate Nexus was founded by a Navy veteran with eight years of active duty service who got tired of watching the system work against the people it was supposed to serve. Confusing processes, hidden fees, $1,500 letters that turned out to be templates — he learned how the VA disability claims process actually works, what makes a nexus letter hold up under scrutiny, and built this service to make that accessible to every veteran at a fair price.
Every nexus letter is reviewed and signed by a board-certified physician in Family Medicine or Internal Medicine. Our team holds active board certification through nationally recognized certifying bodies, maintains unrestricted medical licenses, and renders all opinions independently based on thorough record review.
We do not establish a physician-patient relationship. We do not diagnose conditions. We review the records you provide, evaluate the medical evidence, and render an honest independent opinion — supportive or not.
If the evidence does not support a nexus opinion at the "at least as likely as not" standard (50% or greater probability), we will tell you. We do not write speculative letters, and we do not stretch the evidence. A weak letter does more harm than no letter at all.
Our goal is to provide you with a factually accurate, well-reasoned medical opinion that holds up to VA scrutiny — or an honest explanation of why the evidence falls short.
Physician credentials redacted. All veteran information is fictional.
We're a new service and haven't collected reviews yet. As veterans receive their letters, their experiences will appear here. If you've worked with us and would like to share your experience, reach out — we'd appreciate it.
Submit your records and our team will review your case — usually within two weeks.
Start Your Request$50 record review fee at intake, applied toward your $400 letter. Launch pricing — returning to $500.