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VA Guidance: Two Quicker Options to Appeal a VA Decision

One of the powerful features available to every Veteran is the ability to have a decision made by the U.S. Department of Veterans Affairs (VA) about your healthcare, benefits, and services reviewed and potentially reversed or changed. This is often called "filing an Appeal" or simply "Appealing a decision."

Historically, appealing a VA decision was a complicated process, requiring an in-person hearing before a Judge at VA's Board of Veterans Appeals. This process generally took between three and seven years to resolve, leading to frustration. Often, Veterans hired lawyers, expending personal funds to get what they pointed out was "rightly theirs."

The Appeal process was changed in 2019 and now there are two options (called Lanes) for Veterans to relatively quickly have their decisions reviewed. These are:
1.    Higher-Level Review
2.    Supplemental Claim

For the purpose of the explanation below, I will focus on an appeal of a decision regarding disability compensation. Recall this is a benefit provided for someone injured or disabled while serving. Veterans often appeal a denial of benefits or a granting of benefits that they believe is not appropriate for their circumstances (i.e., the awarded service connection is less than they believe they deserve).

1.    Higher Level Review
This is a review of your existing claim and evidence by a more senior VA employee who handles claims for the specific benefit but did not participate in the previous review and decision. It can be thought of as a second set of eyes on your decision. 

A key benefit of this review is that a more senior VA representative looks at the same evidence and may be able to quickly identify and resolve an error. While you cannot submit new evidence, you can identify where you believe the error was made and where, in the existing evidence, you provided an item that the VA said didn't exist or was missing.

When requesting a higher-level review, you can also request an informal conference with a VA representative to discuss the decision. This is the opportunity to identify the error and explain why you believe another, more favorable decision should have been made. 

Upon the completion of the higher-level review, there are three possible outcomes:
•    The original decision made by the VA is upheld, rejecting the claim for additional benefits.
•    The original decision is overturned, and new benefits are awarded.
•    The original claim is returned to the VA for more work. 

2.    Supplemental Claim
Here, you are asking the VA to reopen your earlier claim because of new and relevant evidence. The definition of new and relevant is particularly important because if the VA determines the additional evidence you provide is not, your Supplement Claim will be denied. Here are the definitions:
•    New evidence – information the VA didn't have before the last decision. It was not part of the information VA previously considered.
•    Relevant evidence – information that could prove or disprove something in your case. Relevant evidence can also raise the possibility of new benefits not previously considered.

The Supplemental Claims process is done entirely by submitting information and documentation. You must describe the issues you want reviewed and produce information that demonstrates the accuracy of your position. The key is to produce new and relevant evidence tied directly to the issues cited that persuades the reviewer to rule in your favor.

With a complete Supplemental Claim, VA will review and determine your claim much like an original or initial claim. At the completion of a Supplement Claim process, you will receive a letter from the VA notifying you of the decision. The favorable decision will indicate the level of benefits awarded. A denial of benefits will provide an explanation.

Other benefit decisions you can appeal
While these explanations focused on appealing a decision for disability compensation, be aware that you can appeal decisions for these benefits:
•    Pension and survivor benefits
•    Fiduciary
•    Education (GI Bill)
•    Veterans Readiness and Employment (VR&E)
•    Life insurance

Need help?
You can get no-cost assistance with your Appeal from a Veteran Service Officer, who can help you complete the forms and file your Appeal. Service Officers have been trained in VA processes. Look for one who is "Accredited" by the U.S. Department of Veterans Affairs, indicating they keep up to date with training and have passed a background screen.

Service Officers are available from:
•    The American Legion
•    Disabled American Veterans (DAV)
•    Paralyzed Veterans of America (PVA)
•    Veterans of Foreign Wars (VFW)
•    Wounded Warrior Project

You can also access a Service Officer from your state Department of Veteran Affairs/Services. 

Instead of using a VSO, some Veterans decide to hire a lawyer to help with their Appeal. If you take this path, take the extra time to understand the business arrangement and expected costs before you sign a contract.
 

Paul R. Lawrence, Ph.D., served as Under Secretary of Benefits at the U.S. Department of Veterans Affairs from May 2018 to January 2021. He is the author of "Veterans Benefits for You: Get What You Deserve," available from Amazon.