Something I tell veterans pretty regularly in Facebook groups and forums — before you spend money on an independent nexus letter, go ask your primary care physician first.
I know that might sound counterintuitive coming from someone who writes nexus letters, but I genuinely mean it. Your PCP knows your medical history, has treated you, and in many cases can write a perfectly adequate nexus letter at little or no cost to you. That relationship matters from a credibility standpoint, and the VA isn't going to dismiss a letter from your treating physician.
So try that route first. Walk in, explain that you're filing a VA disability claim, and ask if your doctor would be willing to provide a written medical opinion connecting your current diagnosis to your military service. Some doctors are very familiar with this and will do it without hesitation.
The reason I still get calls is that it doesn't always go that way. Some PCPs aren't comfortable writing nexus opinions — they'll say it's outside their scope, or they don't want to get involved in VA claims. Some write something that ends up being too vague to carry real weight in an adjudication. And some veterans don't have an established PCP relationship to begin with.
That's when it makes sense to look elsewhere. But I'd rather you find that out after a free conversation with your doctor than spend money before you've explored the obvious option.
