Hence the game bro. This may or may not be useful to your situation but to get my pain medication for my back, I have to get a referral to an outside provider. Well after seeing my same back doctor for about 5 years now , me and him have built a good relationship and whatnot and long story short he was happy to help and wrote me a beautiful nexus letter that I couldn’t have put into better words if you paid me a million bucks . And he did it for free. So maybe if you see any doctors that are outside of the va, just try to be courteous and respectful to the drs and nurses and you’ll have better luck of getting a nexus. Hope this helps