What To Do If You Disagree with a VA Claim Decision
The Veteran Appeals Improvement and Modernization Act of 2017, implemented on February 19, 2019, modernized the claims and appeals process. This process offers greater choice in resolving disagreements with VA decisions.
Typical decisions subject to review include pension, disability compensation, education benefits, reimbursement for unauthorized medical services, and denial of burial and memorial benefits.
A typical VA applicant has one year from the date of the notice of a VA decision to request a decision review from one1 of three options.
However, claimants only have 60 days to file an appeal for contested claims (claims where a favorable decision on one claim requires the denial or a lesser benefit to another claimant). Appeals for contested claims must be filed directly with the Board of Veterans’ Appeals (Board).
Disagreements with VA Claim Decisions
To file a disagreement with a VA decision made on or after February 19, 2019, pursue one of three options: a higher-level review, supplemental claim, or appeal directly to the Board.
You can file a supplemental claim using VA Form 20-0995, Decision Review Request: Supplemental Claim, available at www.vba.va.gov/pubs/forms/VBA-20-0995-ARE. Be sure to identify or submit new and relevant evidence.
New evidence means evidence not previously part of the actual record before agency adjudicators at the time of the prior decision. Claimants may file supplemental claims at any time; however, filing the request within one year of the date of notice of the last decision on the issue(s) maintains potential entitlement to the earliest possible effective date if the VA can grant the benefit.
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Appeals and Supplemental Claims
Higher-Level Review (HLR): A claimant may request a higher-level review (HLR) using VA Form 20-0996, Decision Review Request: Higher-Level Review.
With an HLR, an experienced VA adjudicator who did not participate in the prior decision reexamines the same evidence used for the previous decision and decides the claim without considering that prior decision. The claimant and/or representative may request one informal conference with the higher-level reviewer to identify any errors in law or facts VA made in the prior decision.
The Department of Veterans Affairs must receive the completed VA Form 20-0996 within one year of the date of the notification letter of the prior decision. A claimant may request an HLR for most decisions except immediately following an HLR or a Board decision involving the same issue. For HLRs and supplemental claims, mail forms to:
Disability Compensation
Department of Veterans Affairs
Claims Intake Center
PO Box 4444
Janesville, WI 53547-4444
Life insurance
Department of Veterans Affairs
Attention: Insurance Center
PO Box 5209
Janesville, WI 53547
Pension and Survivor Benefits
Department of Veterans Affairs
Claims Intake Center
PO Box 5365
Janesville, WI 53547-5365
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All Other Benefit Types
Check the decision letter you got for the initial VA claim. You should find instructions on how to submit the form. A Veteran or claimant may appeal directly to the Board using VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) within one year of the date of the VA decision.
Those appealing to the Board may request a hearing and/or have the opportunity to submit additional evidence. The Board can also conduct a review without any additional evidence, which could result in a faster decision. VA Form 10182 should be submitted to:
Board of Veterans’ Appeals
P.O. Box 27063
Washington DC 20038
By fax: 844-678-8979
A Board decision under the modernized program may also be appealed to the U.S. Court of Appeals for Veterans Claims. For additional information on the decision review and appeals processes or to download the appropriate request forms, visit www.va.gov/decision-reviews.
Legacy Appeals
Under the legacy appeals process, for VA decisions issued prior to February 19, 2019, a claimant had one year after the decision to file an appeal by filing a written notice of disagreement with the VA department that made the decision.
Some cases are still pending in the legacy appeals system. In this system, following the receipt of the claimant’s written notice, VA issues the claimant a “Statement of the Case” (SOC) describing the facts, laws, and regulations relevant to the decision in the matter.
When submitting a request for appeal, the claimant must file a “Substantive Appeal,” also known as VA Form 9. This must be submitted no later than 60 days after the SOC is mailed or within one year from the date VA sent out its decision, whichever period ends later.
Claimants with a pending legacy appeal can opt into the modernized appeals system when they receive a SOC or Appeals and Supplemental Claims Supplemental Statement of the Case (SSOC).
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Opting In
To opt in, claimants must submit the required form, electing to opt into the modernized appeals process within 60 days from the date of the SOC/SSOC or within the one-year appeal period. For further information on opting in and to locate the applicable forms, visit the VA official site.
Board of Veterans’ Appeals: The Board decides appeals on behalf of the VA. A VSO, an accredited agent, or an attorney may represent a claimant if desired, but it is not a requirement.
Appellants who wish to have a hearing may present their cases in person to a member of the Board in Washington, D.C., at a VA regional office or by videoconference. Decisions made by the Board on your case can be found by logging into www.va.gov.
A “final Board decision” that does not grant the benefits requested may be appealed using the U.S. Court of Appeals for Veterans Claims. This independent body is not part of the Department of Veterans Affairs.
The court must receive appeals postmarked within 120 days of the decision being sent out. The court reviews the record without holding trials or receiving new evidence. Appellants may represent themselves before the court or have lawyers or approved agents as representatives.
Oral argument is held only at the direction of the court. Either party may appeal a court decision to the U.S. Court of Appeals for the Federal Circuit. Either party may seek review in the U.S. Supreme Court.
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>> Frustrated with your VA disability rating? Get help with increasing your rating to get the compensation you deserve.
About the author
Editor-in-Chief Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter/editor for Air Force Television News and the Pentagon Channel. His freelance work includes contract work for Motorola, VALoans.com, and Credit Karma. He is co-founder of Dim Art House in Springfield, Illinois, and spends his non-writing time as an abstract painter, independent publisher, and occasional filmmaker.
