How much does a VA nexus letter cost?

A VA nexus letter from Flat Rate Nexus costs $549 total, any condition: a $149 refundable deposit at intake and $400 when your letter is ready. Same price for a straightforward tinnitus claim or a multi-condition secondary chain.

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Flat rate
Per nexus letter
$549
any condition, every time
Letter fee (billed on completion)$400
Records review (refundable, at intake)$149
Returning clients$400 at invoicing
Multiple conditionsone letter per condition; some related ones combine
Typical turnaroundwithin 14 days
Not done within 30 days of your complete records? Your $149 deposit is refunded.
What's included
What the $549 actually buys.
A real medical opinion from a real physician, written to the standard a VA examiner reads.

Record review by a board-certified physician

Your service treatment records, post-service medical records, and supporting documents are reviewed by a Family Medicine physician with active licensure and a Navy veteran service background.

Every nexus letter is written and signed by a doctoral-level provider — a board-certified physician or a Doctor of Physical Therapy (DPT). When a DPT authors a letter, a board-certified physician (MD/DO) independently reviews, validates, and co-signs it, so every DPT-authored opinion carries two doctoral-level signatures.

A complete, signed nexus letter

Sections covering qualifications, methodology, records reviewed, history, current diagnosis, medical reasoning, opinion, and references. Cited to peer-reviewed literature, not boilerplate.

Pathway analysis from BVA outcome data

Your case review identifies the strongest causal framing (direct, secondary, or aggravation) by checking your records against 295,756 Board of Veterans' Appeals decisions. We tell you which path has won most often for cases like yours.

An honest answer if it's not yet supportable

If after reviewing the records the physician cannot reach the "at least as likely as not" threshold, you are not charged the $400 letter fee and your $149 deposit is refunded in full. You still receive a written analysis of why and what would strengthen the case.

Page 1 of a sample nexus letter: physician qualifications, methodology, records reviewed and relevant history (fictional veteran, physician credentials redacted)
What you receive: page 1 of a sample letter (fictional veteran, physician credentials redacted). Read the full sample (PDF).
Start My Case Review Most letters delivered within 14 days.

Is there a payment plan?

Yes. The price is already split in two: a $149 refundable deposit at intake, and the $400 balance, which is invoiced when your letter is ready. Nothing is charged automatically. Klarna or Affirm is also offered at checkout on both the $149 deposit and the $400 balance: either one splits the amount into payments, and we add nothing on top. Clients pay the deposit once; returning clients are not charged a review fee again.

If your concern is "what if you pay the $149 and we don't write the letter," the answer is: you are not charged the $400 letter fee, your $149 deposit is refunded in full, and you keep the physician's written analysis of why the case isn't yet supportable. The $149 deposit is refunded in full if we cannot support your case.

Does the price change by condition?

No. Sleep apnea, PTSD, tinnitus, back, migraines: the same $549. A straightforward claim and a multi-condition secondary chain cost the same, with no complexity surcharges and no upsells.

What competitors charge
$549 is not the floor. It's the deliberate price.
Most physician-issued nexus letter services charge between $800 and $1,500. The same letter, written by a physician with similar credentials, often takes longer and costs more. The flat-rate model is what this service is built around.
What it costs Flat Rate Nexus Most other services
Total cost (single condition) $549 per letter $800 to $1,500+
Cost to learn if your case is viable $149 (refundable deposit) Often $0 (then full price for the letter regardless)
Letter fee if case is not supportable $0 Varies; many charge full price
Complexity surcharge None Common, +$200 to $500
Multiple conditions one letter per condition; some related ones combine Often discounted bundles, but per-letter cost still higher
Turnaround within 14 days 2 to 6 weeks typical
Pricing questions
The questions veterans ask before they hit submit.
Real answers, in plain language. If your question isn't here, the full FAQ is on the homepage.

Why is $149 the deposit?

The $149 deposit buys real physician time spent reading your records and writing a viability assessment. It's not a deposit, it's not a hold, it's a discrete piece of work. If the physician can support your case, you then pay the $400 letter fee. If not, you're not charged it and your $149 deposit is refunded in full, and you keep a written analysis you can use to plan your next move. Every client pays the same $149 deposit, refunded in full if we cannot support the case.

How long does it take, and what if it runs long?

Most letters are completed within 14 days. If we haven't completed your letter within 30 days of the date you've submitted all the records we need, your $149 deposit is refunded. The $400 letter fee is never charged until the letter is finished and you've seen it.

What if something in my letter is wrong?

A nexus letter is a dense document. A typical letter of ours contains more than 100 individual facts — dates, providers, unit assignments, test results, and specific findings, every one of them drawn from your own records. We work to get all of them right and we check them before the letter goes out. If we still get one wrong, tell us and we will correct it at no charge, for as many rounds as it takes.

Beyond factual corrections, you also get one round of reasonable edits based on your feedback once you have the final letter — if we developed a point too lightly, gave weight to something minor, or should speak more directly to a prior denial. Please wait for the final letter and send everything in one message: every corrected letter goes back to the signing physician for review and a new signature, so each pass takes real time and each extra pass is another chance for a new error.

What we don't change is the medical opinion itself. That has to stay the physician's independent judgment, and an opinion that reads as written‑to‑order carries less weight with a rater, not more.

Are there any add-ons or upsells?

No. The $549 covers the complete signed letter. There are no rush fees, complexity surcharges, revision charges, or "premium" tiers. Factual corrections are always free, and you get one round of edits on emphasis and approach after you have the final letter.

What about a DBQ (Disability Benefits Questionnaire)?

DBQs are not provided. The service is record-review only, no examinations, telephone consultations, or video visits. We write nexus letters and medical opinions supporting a VA rating-increase claim, each signed by the reviewing physician. Same price for both.

How does payment work?

Two charges: a $149 deposit at intake (Stripe), then a $400 invoice sent after the physician reviews your records and approves the draft. The letter is delivered upon receipt of the $400 payment. Clients pay $400 at invoicing. No subscriptions, no auto-renewals.

One thing we won't do: we won't write a "less likely than not" opinion just to deliver something for the fee. If after reviewing the records the case isn't strong enough to support an honest favorable opinion, we say so, you don't pay the $400 letter fee, your $149 deposit is refunded in full, and you keep the physician's written analysis. Other services that take the fee regardless are part of why VA examiners are skeptical of nexus letters in general.
Start My Case Review Most letters delivered within 14 days.