Record reviewChronology + competing evidence
How it works
From medical records to a clear physician-reviewed opinion.
Nexus organizes the available medical evidence, evaluates the medical questions that need to be answered, reviews relevant literature and competing evidence, and develops one comprehensive report for physician review.
The exact workflow depends on whether you are submitting your own case or working through an attorney or accredited representative.
Intake / case materialsAvailable medical record
Service + treatment recordsExaminations + imagingMedical questions
Evidence reviewMedical analysis file
Medical questionsEach issue defined separately
Literature + analysisEvidence brought together
Independent physician reviewAdopt, revise, or decline
Final work productComprehensive Medical Opinion Report
Starting the case
The medical review is the same. The starting point may be different.
For Veterans
You may be submitting your own records, completing intake forms, identifying prior examinations, or gathering missing documents before the medical review can begin.
- Complete intake
- Provide available records
- Identify medical questions or claimed conditions
- Submit supporting examinations, imaging, and decisions if available
- Respond to requests for clarification if needed
For Attorneys
Your firm may already have the record set, procedural history, and medical questions assembled. When those materials are complete, Nexus can move directly into evidence review.
- Provide organized case materials
- Identify medical questions
- Include relevant C&P examinations and prior opinions
- Provide important case context when medically necessary
- Remain available for factual clarification
The difference is the operational readiness of the file, not preferential medical treatment.
01 — Case intake
Start with the medical question and the available record.
Every opinion begins with understanding what medical question needs to be addressed and what evidence is available.
The better organized and more complete the record is at the beginning, the less time is spent waiting for missing information later.
Case fileAvailable materials
01Intake information02Service records03Treatment records04C&P examinations05Imaging06Medications07Prior decisions08Lay statements
For attorney-referred matters, the firm may provide these materials as an existing case file.
02 — Record review
The record is reviewed as a whole.
Nexus considers the evidence across the full available medical history.
- Chronology
- Diagnoses
- Treatment history
- Service history
- Prior examinations
- Imaging
- Medication history
- Lay evidence
- Favorable evidence
- Unfavorable evidence
- Competing medical explanations
The purpose is not to search only for facts supporting one conclusion. A medically supportable opinion must account for the evidence that cuts both ways.
03 — Medical questions
Each issue has to be answered separately.
The questions remain medical: what relationship, if any, does the evidence support?
A current condition and military service
Is the current condition medically related to military service?
One condition causing another
Did a service-connected condition cause another condition?
A change beyond the expected course
Did a service-connected condition increase the severity of another condition beyond its expected course?
Multiple medical factors considered together
How should multiple conditions, competing risk factors, medications, chronology, and other possible explanations be evaluated together?
04 — Medical literature
Relevant research is used to inform the medical analysis.
Peer-reviewed medical literature may be used when it helps explain a proposed mechanism, risk factor, disease relationship, medication effect, occupational exposure, or competing medical explanation.
Population-level research can support medical reasoning, but it does not automatically prove what occurred in one individual veteran.
Biologic plausibility, disease relationships, and documented effects.
Chronology, risk factors, findings, treatment, and competing explanations.
Research informsMedical reasoning
Integrated medical analysisEvidence before conclusion
05 — Medical analysis
The evidence is brought together before the opinion is stated.
The analysis considers chronology, evidence on both sides, alternative explanations, relevant literature, limitations in the record, relationships between conditions, and patient-specific facts.
The report should show why the medical conclusion follows from the evidence, not simply state a favorable or unfavorable result.
06 — Physician review
The physician independently reviews the medical opinion.
The physician reviews the medical evidence, analysis, and proposed opinions and determines whether to adopt, revise, or decline the conclusions based on independent medical judgment.
The final medical opinion must reflect the physician's own medical judgment.Independent reviewPhysician determination
01AdoptSupported by independent medical judgment
02ReviseMedical reasoning or conclusions changed
03DeclineConclusion not medically supportable
07 — Final work product
One comprehensive medical opinion report.
The completed work product keeps the record, reasoning, and physician opinions together.
- Records reviewed
- Medical chronology
- Medical questions
- Relevant medical literature
- Favorable evidence
- Adverse or competing evidence
- Condition-specific analysis
- Physician opinions
- References
PHYSICIAN-REVIEWED WORK PRODUCT
Comprehensive Medical Opinion Report
Generalized previewDe-identified
Records reviewed
Medical chronology
Medical questions
Relevant medical literature
Favorable evidence
PHYSICIAN
REVIEWED
REVIEWED
Timing depends on the record
Complete records help the review move efficiently.
When the file is still being assembled
Direct submissions may take additional time when records still need to be gathered, intake information is incomplete, or additional clarification is required before the medical review can proceed.
When the file arrives ready for review
Attorney-referred matters may be ready for medical review sooner when the firm provides an organized record set and clearly defined medical questions at submission.
Specific timing depends on record volume, case complexity, the number of medical questions, and whether the materials needed for review are complete.
After review
Questions and factual corrections can be addressed without changing the physician's independence.
Veterans or attorneys may identify factual inaccuracies, missing records, misunderstood questions, or areas that need clarification.
Any requested medical change remains subject to physician independent judgment. Nexus cannot promise that a physician will change a medical conclusion simply because a different outcome is preferred.
What Nexus does
Medical analysis, not legal representation.
- Medical record review
- Medical chronology
- Relevant literature review
- Competing-evidence analysis
- Medical causation and aggravation analysis
- Physician-reviewed medical opinions
- Legal representation
- Claim filing
- Appeals strategy
- Legal advice
- Guaranteed favorable opinions
- Guaranteed VA outcomes
Ready to begin?
Start with the records and the medical question.
Whether you are submitting your own case or working through a law firm, the process begins with understanding the medical evidence that needs to be reviewed.