Why It’s easier in 2023 to Appeal a Disability Claim

The US Department of Veterans Affairs (VA) states that about 30% of all VA disability claims are denied. 75% of them are first-time claims.

The most common reasons for those denials are incomplete information, a lack of evidence, or crucial documentation. Another common and understandably frustrating scenario is when a Veteran receives a much lower VA disability rate than they believe they deserve.

  • At VCU, we strongly recommend securing professional assistance at the start of the process to avoid denial and maximize your benefits. But you should know that the VA’s decision regarding your claim does not have to be final. You can always appeal and defend your right to claim what you have earned in your years of honorable service. 

According to Veteran Appeals Improvement and Modernization Act (AMA) metrics report, about 10% of VA rating decisions are overturned every year after appeal and higher-level reviews.

Recently, the VA updated the process of decision reviews and appeals, providing Veterans with several options to protect their interests. In this Blog, we’ll cover all your options to appeal in-depth. 

Quick Overview of the VA Disability Claim Process

Before diving into what you should do if the VA denies your VA disability claim, let’s review how disability claims are processed in general. It will help you understand what can cause a denial or disputable decision.

Here is a quick overview of the VA disability claims process:

    1. Determination of eligibility
      To be eligible for VA disability benefits, you must be a Veteran with a proven service-related disability and a discharge other than “Dishonorable.”
    2. Initial application
      To start the process, you need to file an initial application for disability benefits (Form 21-526EZ). You can do it online through the VA’s eBenefits portal, by mail, or in person at a local VA office.
    3. Gathering the evidence
      The VA will request relevant medical records and other evidence such as reports from healthcare providers and service treatment records, to evaluate your claim.
    4. Evaluation of your claim
      The VA will review all the submitted evidence and supporting documents to determine the severity of your disability and its connection to military service.
    5. Rating decision
      You receive a disability rating for each condition mentioned in the claim. The rating is based on the severity of the service-related condition and its impact on your ability to work and perform daily activities.
    6. VA decision letter
      You will receive a formal decision letter from the VA. This letter will inform you that the VA has reviewed your case and determined whether your claimed conditions are related to service, the assigned disability rating, and the effective date of benefits. 
    7. Appeals process 
      If you disagree with a VA decision, you have three options to appeal:

      – Supplemental Claim
      – Higher-Level Review
      Board Appeal

      The good news is that if your initial appeal is dismissed, or you are still not satisfied with the results, you can try another eligible option.

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Appeal Process

 

Overview of Your Appeal Options

If you disagree with the decision the VA made on your disability compensation claim, you have every right and more than one option to formally announce your disagreement within one year.

For decisions made before February 19, 2019, there was only one appeal option called a Supplemental Claim. Decisions dated on or after February 19, 2019, can also be addressed through procedures named Higher-Level Review, or Board Appeal.

Let’s take a closer look at each scenario to help you determine which option will work best in your case.

 

 
Closer Look: Supplemental Claim

(VA Form 20-0995)

A Supplemental Claim is the most common appeal option for Veterans today. It is suitable for all disputable decisions made in the past except for denial of Contested Claims, i.e., a claim from a group of people filing for benefits that only one party is entitled to. 

You can file a Supplemental Claim in the following cases:

    • New and relevant evidence
      This means that you may have new information that can affect the VA’s decision. It can be additional medical records, a medical report from an independent healthcare provider, a statement from a family member or those who served with you, etc. This evidence needs to prove that your current condition was caused by a service-related injury, incident, or condition of your military service.

    • Change in law
      You may request a review of your case based on the introduction of a new law or change in legislation, that makes you eligible for the benefits. For example, the introduction of the Promise to Address Comprehensive Toxics Act (PACT Act) has significantly broadened the terms of benefits for Veterans exposed to toxic substances and environments during their service. All you need in this case is a record of qualifying military service.

How to File a Supplemental Claim:

You can file a Supplemental Claim online, by mail, in person, or at your regional VA office. We highly recommend getting help from a professional, as at this point you must collect all the necessary documents and evidence and fill out the form properly in order to avoid another denial.

What Happens After You File:

After filing your Supplemental Claim you don’t have to do anything else but wait for the answer from VA, unless they send you a letter that requires more information or additional evidence on your case. The whole process usually takes about 5 months. However, in 2023, the VA officially announced that from now on, their goal is to complete every Supplemental claim in 125 days, or about 4 months.

In case you receive another denial or still disagree with the VA`s decision, you can file another Supplemental Claim only if you have some new evidence or information that was not included in your two previous claims. Otherwise, you should proceed with a Higher-Level Review or Board Appeal.

Closer Look: Higher-Level Review

(VA Form 20-0996)

If your initial VA disability claim or a Supplemental Claim for your case were denied, or you disagree with the assigned VA disability rate, you have 1 year after receiving the Decision Letter to request a Higher-Level Review. This procedure is supposed to determine if the VA made any errors in proceeding with your case.

It is important to remember that when you request a Higher-Level Review, you cannot submit any new evidence, even if it can help your case. That is why we strongly recommend Veterans file a Supplemental Claim first.

As a part of the Higher-Level Review, you can request an Informal Conference. Technically, it is an opportunity to talk to a higher-level reviewing officer in person and present your version of events more specifically.

You can ask for such a conversation by marking the circle in item 16A on the paper VA Form 20-0996, or in step 3 of the online form.

Before requesting the Higher-Level Review, it is always best to consult a professional, as they may examine your case thoroughly and realize that you may have some additional evidence or information that you did not provide in your original claim or previous request for revision. In this case, you can file another Supplemental Claim and hold the option of a Higher-Level Review until you are sure that all the possible medical evidence or statements that can help your case have already been provided.

Closer Look: Board Appeals

(VA Form 10182)

Requesting Board Appeals means asking a Veterans Law Judge at the Board of Veterans’ Appeals in Washington, D.C., to review your case.

This is normally considered the last possible option to dispute the VA’s decision about your disability rating or VA disability benefits because, unlike with the Supplemental Claim or Higher-Level Review, you cannot request two Board Appeals in a row for the same claim. In other words, make sure that you have already exhausted all other options before requesting Board Appeals.

You have three options if you decide to request Board Appeals:

    1. Request a direct review
      The Veterans Law Judge will evaluate your appeal using the evidence you have already provided. You cannot provide any new information or influence your case in any way.

    1. Submit new evidence
      If you believe that you have new evidence that can support your case, you can submit it within 90 days of the date that you requested a Board Appeal. In this case, the appeal process may last much longer and take up to 1.5 years.

    1. Request a hearing
      A hearing with a Veterans Law Judge can be arranged online or in person at the Board in Washington, D.C. In this case, you will be able to provide all the additional evidence that you may discover at the moment of the hearing or submit it within 90 days after the hearing.

VCU strongly recommends consulting with an expert to make sure that you are making an informed decision as you cannot have two Board Appeals for the same case. However, if you still disagree with the decision made after the Board Appeal, you can file a Supplemental claim and follow the procedure again.

 

The Bottom Line: You Have More Options Than Ever Before

In 2023, Veterans have many more options to appeal a disability claim. Not only can you choose between three procedures, but you can also submit the evidence and even have the hearing on your case online, saving a great deal of time, effort, and money.

Nevertheless, the appeal procedure may take years and require deep knowledge of current legislation and the latest information that can affect your case and appeal options. 

VCU is Here to Help You

Whether you have any questions, feel that you need professional assistance in filing your VA disability claim, or need guidance in the appeal process, schedule a call one of our Veteran Specialists today. Together, we’ll make sure that no stone remains unturned until you claim what you have earned!

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