A nexus letter writer reviews a veteran's medical and service records and writes an independent medical opinion. That opinion links a current condition to military service. This work differs from a C&P exam examiner job, even though both serve veterans filing VA disability claims.
Physicians, nurse practitioners, and physician assistants often choose nexus letter writing for flexible telehealth work. Veterans and their advocates pay for this work directly, not the VA under contract.
Who actually hires nexus letter writers
Veterans and their attorneys hire nexus letter writers directly through telehealth IMO companies, not VA contractors. Several established companies list openings for licensed clinicians who want this work.
- Telemedica hires physicians and nurse practitioners for its telehealth network. The network has served more than 25,000 veterans with nexus letters, DBQs, and mental health evaluations.
- Mednick Associates recruits medical experts across many specialties to write nexus letters for attorneys representing veterans in disability claims.
- Prestige Veteran Medical Consulting is a veteran-owned IMO company. It hires physician assistants and physicians to write opinions for veterans nationwide.
Law firms and veteran advocacy groups sometimes hire nexus letter writers directly for their own caseloads. Some firms front the writer's fee until the veteran's claim is approved. Our guide to the top nexus letter companies compares the providers veterans use to find these writers.
What the job actually involves
A nexus letter writer's core task is a focused records review, not a physical exam. The work centers on documents and a written medical opinion.
- Records review of the veteran's service and VA medical records, plus any private history relevant to the claimed condition.
- A brief interview, usually done by phone or video, to confirm symptom history and current limitations.
- A written opinion stating whether the condition is "at least as likely as not" connected to service. This is the legal standard VA raters apply.
- Supporting rationale that cites peer-reviewed literature and the veteran's specific record. A vague opinion carries little weight with a VA rater.
Most of this work happens remotely. A writer can review records and draft an opinion from a home office. The work happens on their own schedule, without seeing the veteran in person.
How nexus letter writing differs from C&P examining
Nexus letter writing and C&P examining are often confused, but they are opposite roles in the same claims process.
A C&P exam examiner is hired by a VA contractor, such as VES or Optum Serve. That contractor sends the examiner to conduct the VA's own disability exam. The examiner works for the VA's process, not for the veteran.
A nexus letter writer works the opposite side. The veteran, or an attorney representing them, hires the writer directly. The goal is a supportive medical opinion for the claim.
This is advocacy-adjacent work. The writer still reviews the record and forms an independent opinion. The veteran is paying for an opinion that supports their case, not a neutral, VA-commissioned exam.
Some clinicians do both jobs at different times, but the two roles require different mindsets. A C&P examiner documents findings for the VA's rating process. A nexus letter writer builds the medical case that supports a veteran's claim.
Licensing and credentialing basics
Nexus letter writers need an active, unrestricted clinical license, the same baseline required for C&P examiner work. Physicians (MD or DO), nurse practitioners, and physician assistants can all write nexus letters. Their license just needs to cover the condition being addressed.
VA regulations do not require the opinion to come from a physician specifically. Each IMO company still runs its own credentialing process before assigning cases.
Credentialing typically includes a license and background check, plus proof of malpractice coverage. Training often covers how VA raters use the "at least as likely as not" standard.
Some companies also want writers who are comfortable citing peer-reviewed literature to support an opinion.
Why clinicians take these roles
Clinicians take these roles for flexibility, not routine patient care. The structure of the work looks nothing like a standard clinic day.
- Remote, flexible scheduling that fits around an existing practice or another job.
- No prescribing or ongoing patient management, since each case is a records review and a single written opinion.
- Direct, case-based pay rather than salaried employment, typically per letter or per case.
- Meaningful advocacy work that helps veterans document conditions tied to their service.
How to apply
Nexus letter writers apply directly through each IMO company's own site, not through the VA. There is no single, centralized hiring process for this work.
Telemedica, Mednick Associates, and Prestige Veteran Medical Consulting each list openings or a contact page on their site. Reaching out directly, with a current license and CV ready, is the fastest way to start the credentialing process.
Confirming state licensure and malpractice coverage before applying speeds up onboarding. Some companies also ask new writers to complete a short review of sample cases before assigning a full caseload.
See our guide to what a nexus letter is for background on how veterans use this work. The full nexus letter guide for veterans covers the rest of the process.
What a typical case looks like
Most nexus letter writers work through a queue of cases from the IMO company, not a fixed daily schedule. A case starts when the company sends the veteran's records package for review.
The writer reads the service treatment records, VA medical records, and any private records the veteran submitted. A short phone or video call usually follows, to confirm symptom history and cover anything the records leave open.
The writer then drafts the opinion and ties it to specific evidence in the file. The finished letter goes back to the company for delivery to the veteran or their attorney.
Turnaround time matters here as much as it does in C&P work. Companies track how quickly writers complete cases, since a slow opinion can hold up a veteran's claim timeline.
Pay and scheduling expectations
Pay for nexus letter writing is not standardized across the industry, so ask each company directly about current rates. Published averages online are often outdated or specific to one company.
Most companies pay per case or per letter, not a salary, and rates vary by condition complexity and company. Confirm current pay and turnaround expectations directly with each company during the application process. Do not rely on numbers from a forum or an old job post.
Scheduling is generally flexible. Most of the work is records review and a phone or video interview, not fixed clinic hours. Many clinicians write nexus letters as supplemental income alongside a primary clinical job.
Which specialty background fits best
A writer's prior specialty often determines which nexus letter cases a company assigns them. Companies match cases to the clinician's training and licensure.
Primary care and internal medicine backgrounds tend to cover general medical conditions like joint pain, sleep apnea, and hypertension. Psychiatric and mental health clinicians are usually routed to PTSD, depression, and anxiety opinions. These are some of the most requested nexus letter categories.
Specialists in orthopedics, cardiology, and pulmonology can also find steady case volume. Companies like Mednick Associates recruit across many specialties to match the condition in each veteran's claim. Confirm with each company which condition types your license and background qualify you to review.