Do VA doctors have to write a nexus letter?

No. VA policy lets VA providers give an opinion on causality if they choose to, with a clear rationale. Many decline, often because they do not have your service records.

Is a free nexus letter weaker than a paid one?

Not because of the price. VA weighs who wrote it, what records they reviewed, and how well they explained the reasoning.

Does a service officer write nexus letters?

No. A service officer can help you file the claim for free, but the medical opinion has to come from a clinician.

What does Commander Health charge if I cannot get a free one?

A flat $500 for a nexus letter, records review included, after a free screen. The clinician can decline if the records do not support an opinion, and you get your money back if we cannot complete your case.

Can I get a nexus letter for free?

Updated October 4, 2026

You can sometimes get a nexus letter free: your own doctor may write one at no charge, and VA policy lets VA providers give a medical opinion on whether a condition is related to service if they choose to. VA may also obtain its own medical opinion when it needs one to decide your claim. If no one you ask will write one, a private review is the paid option: at Commander Health a licensed clinician reviews your records for a flat $500 and signs only if they support it.

Ask your own doctor first

A treating clinician who knows your history is often a strong author, and asking costs nothing. Ask at a visit, say it is for a VA disability claim, bring the in-service entries from your service treatment records, and ask that the letter explain its reasoning, not just the conclusion.

Ask your VA provider

VA's own policy, VHA Directive 1134, covers medical statements by VA providers. It says providers who wish to give an opinion on causality must include a clear, specific rationale citing the evidence, and should use standard wording such as "at least as likely as not." Providing one is the provider's choice, and many decline.

The directive also notes that VA providers often do not have your military medical records, so bring them.

VA's own medical opinion

Under its duty to assist, VA provides a medical exam or obtains a medical opinion when one is necessary to decide the claim (38 CFR 3.159(c)(4)). That opinion costs you nothing. If it comes back negative or misses the question, you can answer it with an opinion of your own.

Free help that is not a medical opinion

A VA-accredited Veterans Service Organization can help you file the claim for free. A service officer does not write the medical opinion itself; that has to come from a clinician.

When a paid review makes sense

If your doctors decline and VA's opinion went against you, a private records review is the paid option. At Commander Health the free screen runs first; if the evidence is there, a licensed clinician reviews your file for a flat $500, records review included, and signs only if the records support the opinion. Commander Health reviews physical conditions only.

Frequently asked questions

Do VA doctors have to write a nexus letter?: No. VA policy lets VA providers give an opinion on causality if they choose to, with a clear rationale. Many decline, often because they do not have your service records.
Is a free nexus letter weaker than a paid one?: Not because of the price. VA weighs who wrote it, what records they reviewed, and how well they explained the reasoning.
Does a service officer write nexus letters?: No. A service officer can help you file the claim for free, but the medical opinion has to come from a clinician.
What does Commander Health charge if I cannot get a free one?: A flat $500 for a nexus letter, records review included, after a free screen. The clinician can decline if the records do not support an opinion, and you get your money back if we cannot complete your case.