Nexus Letter Cost 2026: Companies and Prices Compared

Published nexus letter prices, rechecked on each provider's own page on September 23, 2026, run from $500 for a single letter (XTerra Health) to $1,595 at Telemedica's standard rate, with specialist tiers and complex opinions higher. Several companies also require a paid records review first, which moves the real starting price: Valor 4 Vet's required $300 review plus its $1,200 letter comes to $1,500, and Vet Resource Group's $250 review plus its $900 letter comes to $1,150. The number to compare is the written, all-in quote for the exact medical question you need answered.

Claim Raven sells software that helps veterans prepare for a nexus opinion, so it competes for some of the same customers and has a commercial interest in this comparison; it does not sell clinical opinions. The table covers 20 providers in the nexus letter and medical-evidence category, including evaluation packages, medical coordination and a DBQ referral service, so not every row is a standalone letter. Each provider links to its full Claim Raven review, and all of them are listed in Claim Raven's nexus letter and medical-evidence provider reviews.

Quick answer

• Sworn Medical lists a $995 standard letter and a $1,495 complex opinion. Its optional $395 records analysis is credited toward the letter.
• XTerra Health lists a $500 letter and says you are not invoiced if a valid nexus cannot be established.
• Valor 4 Vet requires a $300 record review before its $1,200 letter, a $1,500 path.
• Telemedica lists a $325 eligibility review and a $1,595 standard letter, or $620 for eligible third-party members.
• Prestige totals $800 for its review and letter; Claim Climbers totals $795 to $990.
• Military Disability Nexus shows two different starting prices on two pages; get a written quote.
• American Medical Experts, REE Medical and 360 Veteran publish no standard price menu. Ask for an itemized quote.
• DBQ prices are compared separately in the private DBQ cost guide.
• A paid opinion does not guarantee that VA will grant service connection or assign a particular rating.

Nexus letter company price comparison

Valor Psychology shows its prices only inside an interactive booking scheduler that Claim Raven could not read on September 23, 2026, so its prices are left out of this table; see the Valor Psychology review for its services.

The table does not rank medical quality. A lower price does not show that a letter is adequate, and a higher price does not show that VA will find it persuasive.

What a nexus letter fee covers, and what it does not

A nexus letter fee buys a defined professional service, not a VA rating. If you are still deciding whether you need one, start with what a nexus letter is and when it helps. Some providers charge for screening or a records review before a signed opinion. Others quote one letter price but charge separately for an examination, a second condition or a rebuttal. A records-only letter and an in-person or video examination are different services even when both end with a signed opinion.

Work out the real price from the service path, using only published components:

• Sworn Medical: $395 analysis plus the $600 balance equals the $995 standard letter, not $1,390.
• Valor 4 Vet: the required $300 review plus the $1,200 letter is $1,500.
• Vet Resource Group: the required $250 review plus the $900 letter is $1,150.
• MRPY: if the $199 assessment is billed separately without credit, the three packages total $828, $928 and $1,198.
• Prestige: $200 review plus $600 letter is $800. Claim Climbers: $195 review plus a $600 to $795 letter is $795 to $990.
• Amica: $250 review plus the $2,750 evaluation is $3,000, for a psychological evaluation rather than a standalone letter.

For any quote, ask whether the fee covers intake, the appointment, the medical-record review, diagnostic testing, one condition or several, review of an adverse VA opinion, supporting literature, a signed deliverable, factual corrections, follow-up questions and a response if VA schedules another exam. Ask what you receive and owe if the clinician cannot support a favorable relationship. An independent clinician must be free to give an unfavorable or inconclusive opinion when the record calls for one.

DBQs are a separate purchase with their own prices and questions; the private DBQ cost guide keeps them in one table.

Sworn Medical

Sworn Medical says every opinion is personally reviewed, edited and signed by Doug Mayeux, MD, a board-certified emergency medicine physician. Its pricing, checked September 23, 2026, lists:

A secondary claim alone stays at the standard tier. The price is set in writing on the screening call and changes only if the records analysis turns up one of the three complex-tier triggers. Its terms make fees non-refundable once the physician has begun the review, refund in full if you cancel before work begins, and refund the unused portion if the physician declines the requested opinion. The opinion is records-based, with no physical examination and no representation. Read the Sworn Medical review.

XTerra Health

XTerra's pricing page lists a nexus letter at $500 as a flat fee that includes a free consultation, a full medical-record review and a draft for your approval before you buy. It says it does not charge upfront to review medical evidence. Its FAQ says you are notified and not invoiced if a valid nexus cannot be established, a small service fee applies at checkout, and there are no refunds based on VA's decision. Other medical opinions on the same page include specialty opinions for CRSC, DIC, special monthly compensation, Aid and Attendance and TDIU at $600 each, and a Section 1151 opinion at $1,500. The fee buys the service, not a VA outcome; confirm the assigned clinician and the full checkout amount before paying. Read the XTerra Health review.

Valor 4 Vet

Valor 4 Vet posted a dated price update effective August 1, 2026: record review $300, nexus letter $1,200, rebuttal letter $400 and an expedited record-review add-on of $300. A record review must happen before a letter can be ordered, so a buyer starting from scratch faces a $1,500 base path, not a $1,200 line item. Record reviews paid by July 31 kept the older letter price for 90 days after the review result. The company says it uses flat fees, takes no percentage of back pay, and does not provide legal representation without a separate written agreement. Read the Valor 4 Vet review.

Telemedica

Telemedica publishes a service-specific fee schedule in its terms and conditions:

The lower rate is not a general coupon; it depends on an active membership with an eligible third party, and canceling that membership 72 or more hours before the appointment moves you to the standard rate. The terms add a $125 non-refundable Technology and Access Fee for eligibility reviews and evaluations, allow refund requests within seven days of payment, and rule out a full refund once a provider begins what Telemedica calls the Initiation of Services. Ask what amount will appear at checkout and which event makes the payment non-refundable. Read the Telemedica review.

American Medical Experts

American Medical Experts advertises nexus letters and DBQs written by board-certified doctors, with a free consultation and pre-screening. Its homepage, services page and FAQ showed no veteran price menu on September 23, 2026. That does not mean it will not quote; it means you need an itemized written quote that answers:

• how many pages of records are included, and whether imaging costs extra;
• whether an interview or examination is included;
• whether any screening fee is credited to the final document;
• whether processing or financing charges apply;
• what revisions and follow-up responses are included; and
• what amount becomes non-refundable, and when.

Read the American Medical Experts review.

REE Medical

REE Medical says it coordinates independent medical evaluations through a network of outside providers. Its FAQ says all services are flat-rate with no commission, and its compliance page says its fees are never contingent on a rating increase and never deducted from back pay. It does not publish a standard price menu; the homepage advertised a limited-time $400 saving on September 23 without stating the base price. Amounts quoted in customer complaints are not a rate card. Ask for the exact all-in charge, financing terms, cancellation deadline, refund rules, the examinations and DBQs included, and who examines you and signs the document. Read the REE Medical review.

Other nexus letter and medical-evidence providers

Each entry was rechecked on the linked first-party page on September 23, 2026.

360 Veteran. Its services page offers a free medical-records review, then one fixed price for your case, based on your situation. It lists nexus letters, DBQs and independent medical opinions without a numeric fee schedule. Read the 360 Veteran review.

Amica Clinical Consulting. Its veteran evaluation page lists a free email pre-screening, a required $250 records review and a $2,750 psychological evaluation, $3,000 in total. The evaluation covers mental-health conditions only and includes a written nexus opinion when applicable. Read the Amica Clinical Consulting review.

Claim Climbers. The pricing page lists a $195 records review and letters at $600 to $795 each, so review plus one letter is $795 to $990. It refunds the review fee if the review cannot identify any condition that could be supported with a letter; that is not an outcome guarantee. Read the Claim Climbers review.

Dr. Willoughby and Associates. The evaluation page describes psychological independent medical examinations by licensed psychologists, delivered in 7 to 10 business days, with a diagnosis if clinically indicated and a nexus opinion if appropriate. No numeric fee is shown there. Read the Dr. Willoughby and Associates review.

Military Disability Nexus. Its services menu shows the nexus letter "starting at $400+" and a claim readiness review starting at $225. Its nexus letter page shows internist or specialist opinions from $945 and subspecialist opinions from $1,800, while the services page says there is no single flat price and that it quotes after an initial assessment. Treat both as starting figures and get a written quote. Read the Military Disability Nexus review.

MRPY Professional Services. Its price chart lists a $199 medical evidence assessment, letter packages at $629, $729 and $999, and $549 for each additional letter; its nexus page makes the assessment the first step. Ask whether the assessment is credited toward the package. Read the MRPY Professional Services review.

Prestige Veteran Medical Consulting. The service menu lists a one-time $200 records review and $600 per letter, $800 together; 48-hour express service adds $200 per letter. Read the Prestige Veteran Medical Consulting review.

Seven Principles. The homepage lists $750 for one DBQ or nexus letter, or $500 each when buying two or more, so two documents cost $1,000 in total. Read the Seven Principles review.

Todd Finnerty. Dr. Finnerty's fee schedule lists $600 for a records-review nexus letter, charged per letter rather than per condition, with no examination. A later letter for a different condition is typically $300 for a returning client. Read the Todd Finnerty review.

Vet Nexus Letter. The pricing page lists $650 for a mental-health or PTSD opinion on one condition and $100 per additional condition, with multiple mental-health disorders counted as one; a rebuttal analysis of a prior denial adds $200. Read the Vet Nexus Letter review.

Vet Resource Group. Its nexus letter page lists a required $250 record review and strategy consult (up to 2,000 pages) and a $900 letter, $1,150 in total; a second letter is $700 and each additional one $650. Physical and mental-health opinions need separate experts and letters. Read the Vet Resource Group review.

Woobie. Woobie's terms separate its software from a paid connection to independent medical providers who perform DBQs, independent medical opinions and nexus letters, and make those medical services non-refundable once work has begun. No public price for the connection was found. Read the Woobie review.

The DBQ Source and Trajector Medical. The DBQ Source's nexus page refers nexus letters to a partner, NexusLetterDoctor.com, so its DBQ fee is not a nexus price; read The DBQ Source review. Trajector Medical shows no public price on its site; the Trajector Medical review covers its contract history.

What Board decisions show about who writes the opinion and how well

Claim Raven's analysis of Board of Veterans' Appeals decisions from mostly 2024 and 2025 records how the Board described the medical opinion on each issue. Where the Board described the opinion as strong, 89.7% of 12,502 condition records ended favorably. Adequate opinions: 69.2% of 18,592. Weak opinions: 3.7% of 18,253. No opinion: 1.6% of 10,700.

The author of the opinion showed a much smaller gap between a paid outside examiner and a veteran's own doctor. Opinions from a treating physician were associated with a favorable outcome in 78.5% of 2,613 records, private independent examiners in 73.8% of 6,827, and VA examiners in 36.9% of 35,160.

Read those numbers with three limits in mind. The Board's quality label partly reflects its own conclusion, so a strong opinion and a favorable outcome are not independent. Board appeals are claims that were already denied or disputed, so these describe patterns, not your odds. And they are associations, not causes. Within those limits, a paid outside opinion is not associated with better Board outcomes than an opinion from your own treating doctor; the quality the Board assigns, not the invoice, is what tracks with outcomes. Claim Raven's evidence statistics split decisions with private opinions by the Board's quality rating.

Who signs matters in a narrower way. In one appeal, two chiropractor letters got no weight because they contradicted the provider's own records and showed no records review. In another, one private physician assistant's opinion won a neck claim. Credentials help the Board trust the reasoning; they do not replace it.

A real appeal shows why a favorable conclusion is not the whole service

In Board Decision A25094396, October 30, 2025, a private clinician linked the veteran's hearing loss and tinnitus to service. The Board found that opinion insufficient because it did not support its conclusion with an analysis the Board could weigh. It also found problems in the VA opinions. Both issues were remanded for further medical opinions; the favorable private conclusion did not produce a grant.

The decision does not state the private provider's fee or name any company in the table above, and it says nothing about price and quality. Its lesson for a buyer is narrower: "a signed favorable letter" and "an explained medical opinion addressing my records" are different deliverables. Add these questions to the quote conversation:

• Which records and competing explanations will the clinician consider?
• Will the opinion explain how those facts support the clinician's independent conclusion, including an unfavorable or uncertain one if warranted?
• If an existing VA opinion is part of the question, does the quoted work include reading and answering its actual reasoning?

These are scope questions, not a script for a favorable opinion. This one remand cannot predict how VA will weigh another opinion, but it shows what to inspect in the delivered report. How to review a nexus opinion covers that check in more detail.

A buying worksheet for any clinician

Fill out one copy per quote. Leave a blank visible rather than assume the answer.

Review a sample deliverable for reasoning and record citations, not a promised rating.

Lower-cost options to check first

Ask an accredited VSO. An accredited Veterans Service Organization representative can review the claim for free and help identify the missing element. Verify the organization and the assigned representative in VA's accreditation directory.

Ask a treating clinician. A treating clinician may be willing to review the records and write an opinion as part of care, for a separate fee, or not at all. Do not ask for a preselected conclusion. In the Board figures above, treating-physician opinions were associated with favorable outcomes at least as often as paid outside opinions.

Use the VA examination process. VA may schedule a claim exam at no cost to you. A private purchase does not cancel it; do not skip a scheduled exam on a private company's advice.

Read the decision first. VA's evidence guide explains that what a claim needs depends on its type, and some conditions are presumptive. If your decision says a different element is missing, a new opinion about the relationship may not fix it.

How Claim Raven compares

Claim Raven is self-service software. It does not examine you, sign nexus opinions or DBQs, represent you, file claims or promise outcomes.

Raven Nexus includes one starter assessment with a free account, which can check a letter you already have or assess selected records. Full letter drafts for a clinician to review need Standard or Plus; see the pricing page for plan allowances. A draft helps you organize the question and records for a clinician. It is not a medical opinion, and the clinician makes the independent judgment and decides whether to sign anything.

Bottom line

There is no single cheapest service for every medical question. A records-only letter, a specialist opinion, a psychological evaluation and a coordinated evaluation package are different work. Compare the full required sequence: Prestige's review and letter total $800, while Valor 4 Vet's total $1,500 and Vet Resource Group's $1,150. Then compare the clinician's fit, the records reviewed, the reasoning, the revision policy and the refund cutoff. Pay for a defined medical question, not a promised VA result.

Sources and limitations

• Provider pages checked September 23, 2026: Sworn Medical and terms; XTerra pricing and FAQ; Valor 4 Vet price update; Telemedica terms; American Medical Experts; REE Medical FAQ and compliance page; 360 Veteran; Amica; Claim Climbers; Dr. Willoughby and Associates; Military Disability Nexus services and nexus letter page; MRPY prices and nexus page; Prestige; Seven Principles; Todd Finnerty; Vet Nexus Letter; Vet Resource Group; Woobie terms; The DBQ Source; Trajector Medical.
• Board figures: Claim Raven's analysis of Board decisions, mostly 2024 to 2025, counted in condition records; see Claim Raven's Board statistics. Board Decision A25094396 was read in full on September 23, 2026.
• Prices, provider networks and refund terms change. Confirm the current contract and invoice before paying.