i.
Records cited.
Service Treatment Records, post-service VA records, private medical records, prior C&P examinations, and lay statements are reviewed and referenced by date and source. Nothing is asserted without a citation.
Memphis, Tennessee · Independent Medical Reviewer
A medical opinion that holds up when the case goes to a judge.
Independent medical opinions and nexus letters for VA disability claims, written by a physician trained in Internal Medicine and Nephrology with more than eighteen years of clinical experience.
Statement of Practice
When the medical record supports a service-connection opinion, I write it. When it does not, I tell you so in writing, with reasoning — before counsel relies on it.
— Dr. Natarsha Grant
01 / Principles
What every opinion contains.
ii.
Mechanism explained.
The pathophysiologic basis for the opinion is described in plain clinical language. A rater or BVA judge can follow why the proposed connection is medically plausible without consulting an outside specialist.
iii.
Alternatives addressed.
Plausible non-service etiologies are named and weighed. An opinion that ignores obvious alternative causes is an opinion that loses on appeal. I make sure the file shows the work.
iv.
Literature attached.
Where appropriate, peer-reviewed sources supporting the mechanism are cited and, on request, attached. KDIGO, ATS, ADA, AHA, and other society guidelines, as the condition warrants.
v.
The standard, exactly.
Where the evidence supports it, the opinion uses the precise phrase “at least as likely as not (50% probability or greater)” — the standard the VA requires and the language adjudicators look for.
vi.
Or a written no.
If review concludes the evidence does not support a favorable opinion, I issue a written summary of findings instead. A weak nexus letter damages a client’s credibility on every adjacent claim. I will not write one.
02 / Scope
Conditions within practice.
Renal & Hypertensive
Kidney and blood-pressure conditions.
Hypertension · Chronic Kidney Disease (all stages) · End-Stage Renal Disease · Proteinuria and glomerular disease · Nephrotoxic medication exposure · Contrast-induced nephropathy · Hypertensive nephrosclerosis · Diabetic nephropathy
Cardiometabolic
Endocrine and cardiovascular.
Type 2 diabetes mellitus · Dyslipidemia · Obesity and metabolic syndrome · Thyroid disease · Ischemic heart disease (within Internal Medicine scope) · Heart failure with preserved ejection fraction
Toxic Exposure
Service-related exposure sequelae.
Burn pit and airborne hazard exposure · Camp Lejeune water contamination claims · Agent Orange-related Internal Medicine conditions · Gulf War illness presentations within IM scope · Heavy metal and solvent exposure sequelae
GI, Sleep, Other IM
Internal Medicine, broadly.
Gastroesophageal reflux disease · Irritable bowel syndrome · Sleep apnea workups (Internal Medicine perspective) · Electrolyte and acid-base disorders · Secondary service-connection chains across IM diagnoses
Referred to specialists
Psychiatric (PTSD, depression, anxiety), orthopedic, neurosurgical, and oncologic conditions are best opined on by specialists in those fields. I will say so directly and, where helpful, suggest a colleague.
03 / Process
From intake to written opinion.
01
Intake
Send the records package: DD-214, STRs, VA and private records, prior C&P exams, denial letters, and any lay statements. A signed engagement and HIPAA release accompanies it.
02
Review & examination
I personally read the file. Where appropriate, the engagement includes an independent medical examination of the veteran (in-person at the practice or via secure telehealth) and completion of relevant DBQs. No ghost-writers, no template assembly, no opinions rendered without records review.
03
Honest gate
If the evidence supports a favorable opinion, the letter is drafted. If it does not, you receive a written summary explaining what the file shows and why a nexus opinion would not survive scrutiny.
04
Delivery
Standard turnaround is 10–14 business days. Rush turnaround under 7 business days available. Clarification calls, addenda, and supplemental opinions on request.
04 / At Intake
What to send first.
Cases move faster when the first submission is complete. The materials below should accompany every new case. Anything missing can be requested afterward, but a complete intake shortens turnaround by several days.
- 01DD-214 (Certificate of Release or Discharge)
- 02Service Treatment Records, complete
- 03VA medical records relevant to the claim
- 04Private medical records relevant to the claim
- 05Prior C&P examination reports
- 06VA rating decisions and denial letters
- 07Lay statements or buddy statements
- 08Signed engagement and HIPAA release
For Counsel
VA-accredited attorneys and claims agents.
I work with attorneys and accredited claims agents who need a credible, defensible Internal Medicine or Nephrology opinion within a tight deadline. Volume arrangements are available for firms with three or more active cases per quarter.
Open a caseFor Veterans
Veterans engaging directly.
Veterans are welcome to engage directly, with or without legal representation. I will tell you honestly whether a nexus opinion is supportable before any fee is charged. If your case is stronger with counsel, I will say so and, where helpful, suggest options.
Inquire05 / Reviewing Physician
Natarsha Grant, MD
Internal Medicine & Nephrology
Dr. Grant is a physician trained in Internal Medicine and Nephrology with more than eighteen years of interventional clinical experience. Her practice has spanned the longitudinal management of chronic kidney disease, hypertension, diabetes, cardiometabolic disorders, and the complex polypharmacy and exposure histories that characterize the veteran population.
She is co-founder of Bluff City Health & Wellness in Memphis and previously co-founded Bluff City Vascular, where her practice focused on dialysis access interventions. That procedural experience with patients in chronic kidney disease and end-stage renal disease directly informs her review of nephrology and renal-related VA claims. For independent opinion engagements she acts solely as a reviewer and does not establish a treating relationship with veterans whose claims she opines on.
06 / Questions
Asked most often.
i. Does this engagement create a treating-physician relationship?
No. Engagements are for independent medical review and opinion writing only. Dr. Grant does not prescribe medications, manage conditions, refill prescriptions, or provide ongoing medical care for veterans whose claims she reviews. The engagement letter makes this explicit and the engagement is structured to keep IME work cleanly separate from any treating practice.
ii. Is a favorable opinion guaranteed?
No. The opinion follows the medical evidence in the file. Where the record does not support a favorable nexus opinion at the “at least as likely as not” threshold, the engagement closes with a written summary explaining why — not with a weak letter. Counsel typically prefers the honest no, since unsupported letters damage a client’s credibility on adjacent claims.
iii. Who can submit a case?
Both VA-accredited attorneys and accredited claims agents, and veterans engaging directly, are welcome to submit cases. Cases falling outside Internal Medicine or Nephrology scope — psychiatric, orthopedic, neurosurgical, oncologic — are declined and referred to a specialist in the relevant field. If your case is stronger with legal representation, I will tell you so before any fee is charged.
iv. What is the standard turnaround?
Ten to fourteen business days from receipt of a complete records package. Rush turnaround under seven business days is available depending on file size and current scheduling. A small active caseload is maintained intentionally so deadlines hold.
v. Do you perform examinations as part of the review?
Yes, where appropriate or requested. Engagements may include an independent medical examination of the veteran — in-person at the practice address in Memphis, or via secure HIPAA-compliant telehealth — together with completion of relevant Disability Benefits Questionnaires (DBQs). Examination findings, when present, are incorporated into the rationale of the written opinion. An examination does not establish a treating relationship; the engagement remains independent throughout.
vi. How are fees structured?
Fees are quoted per case following intake review of the file and any examination requirements. The quote reflects file size, number of conditions, complexity, examination needs, and turnaround. Fees are payable in full prior to release of the written opinion and are charged for professional time and analysis, not contingent on the outcome of any VA decision. The engagement letter sets out the full fee structure for each engagement.
vii. How is the practice scope limited?
Reviews are limited to Internal Medicine and Nephrology. Psychiatric, orthopedic, neurosurgical, and oncologic opinions are best obtained from specialists in those fields, where the VA assigns greater probative weight. Cases falling outside scope are declined at intake before fees attach.
07 / Contact
Open a case file.
Send a brief description of the veteran’s claimed condition and the records available. You will receive a response within two business days with availability, fee, and a records-release form.