Strategic Medical Evidence Intake

Please complete the following questionnaire. This data allows our medical team to determine the "Missing Link" in your current evidence and assess the viability of a Nexus Letter for your claim.

Veteran Identity & Service History

Full Name *

Date of birth *

Branch of Service: *

Dates of Service:

Service Entry Date *

Date of Discharge / Separation *

Total Years of Active Duty: *

Medical Status & Evidence Review

Primary Condition(s):

What specific conditions are you seeking a Nexus for? *

Connection Type:

Are you seeking a Primary Connection, a Secondary Connection, or both? *

Primary Connection Only (Occurred in service)

Secondary Connection Only (Caused by an existing service-connected condition)

Both Primary & Secondary Connections (I have multiple conditions)

Medical Documentation:

Do you have existing VA medical records or private treatment records documenting these conditions? *

Yes

DBQ Status:

Do you already have a completed Disability Benefits Questionnaire (DBQ), or do you require one to be completed by our medical team? *

I have a completed DBQ

I need a DBQ completed

VA Claim History & Strategy

Current Combined Rating:

What is your current disability rating? *

Active "Intent to File" (ITF):

Do you currently have an active Intent to File on record with the VA? *

Yes

Not Sure

Status of Claim:

Have you received a recent Decision Letter or Statement of the Case (SOC) for a denied claim? *

Yes

C&P Exam History:

Has a Compensation & Pension (C&P) Exam already occurred for this specific condition? *

Yes

Deployment & Exposure (PACT Act Eligibility)

Presumptive Locations:

Did you deploy to an overseas combat zone or recognized hazard area (such as Vietnam, Iraq, Afghanistan, or the Middle East)? *

Yes

Environmental Hazards:

Were you exposed to environmental hazards such as Toxic Burn Pits, Agent Orange, or contaminated water? *

Yes

Administrative

How did you find Federal Claims MDs? *