How To Appeal a VA Disability Denial
Disability benefits from the U.S. Department of Veterans Affairs provide financial assistance to veterans who have a disability that was either caused or worsened by their military service. These monthly disability benefits can take a while to begin, as the VA claim and decision process can be lengthy. Sometimes, a VA decision does not go in the veteran’s favor, resulting in a denial and VA disability appeal.
How To Appeal a VA Disability Claim Denial
- Supplemental Claim
- Higher-Level Review
- Board Appeal
Veterans have a few options if they choose to move forward with a VA disability appeal, but they must follow an appeals process to escalate the appeal. Most veterans begin with a Supplemental Claim to add new evidence to their current disability claim. If the VA still sends a denial letter, veterans can seek another claim decision through a Higher-Level Review or Board Appeal.
It’s essential to understand the VA disability benefits claims and appeals process before submitting a veterans claim for disability benefits. A disabled veteran can seek the help of an experienced attorney or Veterans Service Officer (VSO) to submit their initial claim with the best possible chances of a successful claim decision.
What Is the Appeals Modernization Act?
The Veterans Appeals Improvement and Modernization Act, also known as AMA, was signed under President Trump in 2017, officially becoming law in 2019. AMA brought about some of the most groundbreaking changes to the VA disability appeal and claims process.
One of the most significant changes was the requirement of the VA to assist veterans with their disability claims until each claim has been approved or denied. In other words, veterans have the right to assistance with the VA disability claims process until the VA reaches a decision.
The AMA also overhauled the veterans appeal process for disability compensation claims. The new law brought forth a more streamlined way to appeal a disability claim denial, offering veterans the option of submitting a Supplemental Claim, seeking Higher-Level Review, or getting a board review.
The law also ensures that the VA provides detailed reasoning for a veterans disability claim denial so that a disabled veteran can determine the best way to begin the appeal process if they choose to do so. VA notices need to include why a claim was denied, what evidence went into the decision, and how veterans can obtain additional evidence if needed.
Perhaps most important to veterans is the AMA’s requirement to review VA claims faster. The AMA created a simpler, more modernized way for the VA to process claims in an attempt to bump down the average claim processing time to reach a decision faster. The law also made the VA disability appeal process faster for any type of appeal.
Additional changes to the veterans disability benefits claims and appeal process include binding veteran-favorable claims decisions unless ample evidence proved otherwise, and allowing veterans up to one year to appeal a VA disability claim decision.
How To Appeal a VA Disability Claim Denial
VA disability benefits are some of the most valuable benefits for veterans. However, not all disabled veterans are eligible for the benefits, and some must go through rounds of appeals to get an approval. Currently, about 30% of VA disability claims get denied.
Veterans should know that they have options after receiving a denial. The VA disability appeal process allows for three different types of appeals veterans can file to receive compensation. The veteran can choose which route to take depending on their specific case.
While the process to appeal can be frustrating and lengthy, it’s worth it if you believe you rightfully deserve VA benefits. According to 2020 data from the VA Board of Veterans’ Appeals (BVA), the BVA approved 33.8% of legacy appeals brought to it for review and remanded – sent back to the veteran for more evidence or changes – another 40.6% of legacy appeals. The BVA approved 37% of AMA appeals and remanded 28.2% of them.
The following sections detail each of the three appeals processes under the modern AMA law.
1. Supplemental Claim
A Supplemental Claim is typically the quickest and most straightforward type of appeal. Veterans can submit new or relevant evidence to the VA for review with this process. Essentially, this evidence should support your denied claim by providing either brand-new evidence of your disability or relevant evidence that proves information in your claim. A Supplemental Claim is typically best for veterans who believe that additional information or evidence could help their claim push through to approval.
Eligibility for a Supplemental Claim
Supplemental claims are only for veterans who have new or relevant evidence to add to their original claim. Any new or relevant evidence a veteran uses during this appeals process must be evidence that wasn’t originally in the claim.
Because Supplemental Claims aren’t solely for appeals, a veteran can submit one at any time. For example, a veteran might submit a Supplemental Claim if they see a new doctor that provides a similar diagnosis to one they’ve already received and they believe this evidence will help support their original claim.
However, for appeals, the VA recommends filing one within one year from the date of your decision letter for a timelier decision process. This way, it has the most up-to-date information about your case with less likelihood of needing to schedule additional exams and gather evidence that could take more time.
What To Expect From the Supplemental Claim Process
To file a Supplemental Claim, a veteran should fill out and submit VA Form 20-0995. On this form, you can indicate that you are submitting the claim in response to a VA disability denial and list the issues you disagree with. Then, you may either submit the new or relevant evidence you have or fill out the information for the VA facility or non-VA provider that has the evidence. In the latter scenario, the VA will help you locate the evidence to add to your claim.
Once the VA gathers any evidence you have requested, a VA claims adjudicator reviews your original claim and Supplemental Claim, considering any new and relevant information you’ve included.
If the VA determines that it still needs more information to support your claim, it may request that you complete an exam or testing to get the data it needs. Be sure to check for any mail from the VA during the Supplemental Claims process, which may include an appointment date and time. Be diligent about attending scheduled exams to avoid delays in the process.
What Happens After Submitting a Supplemental Claim
The VA currently takes about 4-5 months to review and decide on Supplemental Claims cases. Once it reaches a decision or determines that more information is necessary to process your claim, you’ll receive a letter in the mail. If you receive another denial, you can then escalate your claim to a Higher-Level Review or Board Appeal.
2. Higher-Level Review
A Higher-Level Review is almost like a second-tier decision review system for disability claims. In this process, a more experienced decision review officer evaluates your claim and forms a decision for your appeal. The new reviewer may decide to validate the previous reviewer’s decision or push through your claim in your favor, considering all evidence and information you submitted with your original claim.
This appeals process can occur when the VA has already denied an original or Supplemental Claim. You do not need to first appeal with a Supplemental Claim and can move straight to the Higher-Level Review process if you choose.
Eligibility for a Higher-Level Review
Unlike a Supplemental Claim, a Higher-Level Review cannot contain any new evidence for the VA to review. Instead, it must only include your original claim or your Supplemental Claim if you believe that either one was not reviewed the first time accurately.
What To Expect from the Higher-Level Review Process
The Higher-Level Review process does not allow you to receive help from the VA to gather additional evidence for your claim because you cannot add new evidence. However, you do have the option of speaking with a Higher-Level Reviewer about your claim or having your representative do it for you.
With this option, the reviewer will schedule a time to call you or your representative to discuss the details of your claim and appeal. You can use this time to explain what you believe should be changed in your claim decision, such as your disability rating or disability denial. The reviewer may also discuss errors found in your case that you might be able to correct to assist your appeal.
This conference is informal and should be treated as such. Nothing you say will count against you during the call. Instead, it’s simply an informational call to discuss your case with a reviewer to make sure the Higher-Level Review is the best option for you and provide some background to your case.
To file for a Higher-Level Review, you should submit VA Form 20-0996. If you’d like to speak with a Higher-Level Reviewer prior to the review, you can indicate that on the form. Also, mark what information you’d like reviewed when filing. If you need help completing or submitting the form, you can contact your Veterans Service Organization or a VA attorney to assist.
What Happens After Filing for a Higher-Level Review
After you submit your VA disability appeal and request a Higher-Level Review, you should expect to wait four to five months for a decision, although some cases may be quicker or take longer. Some veterans may need to attend VA doctors’ appointments for additional testing or exams, similar to a Supplemental Claim. Attend any appointments the VA schedules you for a smooth process.
If you still do not agree with the decision from a Higher-Level Review, you may move on to a Board Appeal.
3. Board Appeal
The final potential solution for your VA disability appeal is a Board Appeal through the BVA. A BVA appeal can happen when trying to appeal an original claim, Supplemental Claim, or Higher-Level Review decision, so it’s an appeal option for any claim.
This VA appeals process allows the veteran to choose from three options. First, the veteran can request a Direct Review by a Veterans Law Judge. The Veterans Law Judge will review any information you already submitted and make a Board decision based on that information, similar to a Higher-Level Review.
The second option allows a veteran to submit additional evidence for a decision review by a Veterans Law Judge. If you have any extra information to provide that you either received after your claim or didn’t include with your claim, you can add it with this option.
Lastly, veterans can request a hearing with a Veterans Law Judge. This can either be held in person or virtually. It may be the best option for veterans wishing to discuss their case with the Veterans Law Judge and listen to the decision process.
Eligibility for a Board Appeal
Veterans can choose to request a Board Appeal for any type of appeal, including original claims, Supplemental Claims, and Higher-Level Reviews. If you want to submit any new evidence with your claim, you must do so within 90 days of filing your Notice of Disagreement (NOD) to request a Board Appeal.
What To Expect from the Board Appeal Process
The Board Appeal process takes longer on average than other claims appeals. Typically, a Direct Review is the quickest route, but it still could take about one year. Submitting more evidence and requesting a hearing with the Board could each take more than one year.
It’s a good idea to speak with a VA disability attorney or a VSO before filing for a Board Appeal to determine which option is best for your case. After discussing your case, you might find that a different appeal option could be beneficial and save you time waiting for a decision.
What Happens After Filing for a Board Appeal
The Board Appeal is the highest tier of appeals for VA disability benefits claims. However, veterans may choose to submit additional evidence they may have received after their appeal by filing a Supplemental Claim. You can do this even if you’ve already filed a Supplemental Claim in the past.
Additionally, veterans are allowed to escalate their appeals to the U.S. Court of Appeals for Veterans Claims. The VA allows you 120 days from the date of your BVA appeal decision to file for a court appeal.
What Is a Legacy Appeal?
Legacy appeals are any appeals for VA disability benefits originally dated before February 19, 2019, when the AMA officially became law. Beginning on this date, the VA disability appeal process shifted to allow a more straightforward and speedier resolution process for veterans.
However, the VA kept the old appeals process open so that it could still process current appeals. As a result, any legacy claims fall under the prior process of appeals, while those dated on or after February 19, 2019, immediately went under the new system.
It’s important to note that the legacy appeal process could take longer for the VA to reach a decision. The VA website states that these appeals typically take between 12-18 months for the VA to conduct a review of the appeal, and it may take as much as seven years for a BVA review.
Still, veterans with open legacy appeals could file a new appeal, which would fall under the new AMA appeals system. If a veteran with a legacy appeal files a Notice of Disagreement (NOD) for the VA’s decision, the VA then sends a Statement of the Case (SOC) if it still determines that not enough evidence is available to approve a claim. If the SOC is dated on or after February 19, 2019, the veteran may choose to either continue the legacy appeals process or switch to the AMA appeals process. The VA allows veterans 60 days from the SOC’s date to opt in to the new appeals process.
Under the new AMA appeals process, veterans can choose between the three options for VA disability claims. Veterans have one year from the date of their denial to move forward with an appeal, whether they’d like to appeal their disability claim denial or disability rating decision.
How To Check Your VA Appeal Status
The easiest way to check your VA disability appeal status is to create an online account with the VA website. If you have a DS Logon, ID.me account, or MyHealtheVet account, you can use your credentials to sign in to the VA website and check your appeal status. If you don’t currently have one of these accounts, you can create an ID.me login to get started.
On your My VA dashboard, you’ll find a link to ‘Track Claims.’ Click that link to see your current claims and get their status. The website will include all information submitted online with that claim, including your application and any medical evidence. However, anything you’ve mailed, faxed, or brought into your local VA office won’t be available on the website. You’ll also see details for your VA representative, whom you can contact about your claim.
The site displays the current step your claim falls on in the process, such as the initial review or evidence gathering. You should receive a notification when the claim escalates to the next step.
If you are unable to check your appeal status online through the VA website, you can contact your local VA office or your VA representative directly for assistance.
Should I Hire a VA Disability Lawyer?
A VA disability lawyer is well-versed in veterans law and regulations surrounding VA disability claims. This type of attorney can guide a veteran through the appeals process to ensure that the veteran has supplied all necessary information to the VA. They also uphold the best interests of the veteran throughout the appeal.
A disability attorney may help you find more success with your claim appeal. According to the Board of Veterans’ Appeals 2020 data regarding VA disability appeals, attorneys were responsible for getting the most legacy appeals allowed by the Board at 40.9%.
Other organizations, like AMVETS, the American Legion, and Vietnam Veterans of America, had lower approval rates. Additionally, cases with the assistance of a VA disability lawyer were less likely to get denied by the Board than others, with a 14.8% denial rate.
Consider the following benefits of a disability lawyer for a VA disability appeal:
- Experience: These attorneys have more experience than you do with the appeals process because they’ve been through it multiple times. They know the typical procedures and can guide you through each step.
- Communication: Your attorney will keep in close contact with you to update you on your appeal. They’ll also reach out to doctors and the VA on your behalf to get any information necessary.
- Expertise: An attorney’s deep understanding of each type of appeal allows them to suggest the best path for your case. They’ll also dig into why your claim was denied in the first place to make it easier to gather the appropriate evidence.
- Affordability: Many VA disability attorneys only charge veterans a fee once they’ve successfully won a case and helped the veteran recover money to which they were entitled.
Understanding the VA Disability Appeal Process
Like VA health benefits and education benefits, eligible veterans can receive VA disability compensation for service-connected disabilities. Although the VA denies many claims, the appeals process has been reconfigured to make it simpler and quicker for veterans to appeal, thanks to the Appeals Modernization Act.
Veterans can choose one of three paths: Supplemental Claim, Higher-Level Review, and Board Appeal. Each path’s eligibility requirements vary and cater to different circumstances.
Consider working with an attorney who knows what your claim needs for its best chance at approval. A VA disability attorney can help you decide which path is best for your situation. Contact our attorneys today for a free legal consultation.