VA Higher-Level Review: A Complete Guide to Appealing a VA Decision Successfully
There is nothing more disappointing and frustrating than receiving a formal VA decision that fails to recognize or account for the benefits you deserve. Luckily, veterans are given a few unique ways to appeal these types of decisions; one of the quickest and easiest appeal processes is through VA Higher-Level Review.
A VA Higher-Level Review allows a more experienced reviewer in the Department of Veterans Affairs to perform an independent review and reconsideration of your claim decision without requiring new or additional evidence. When you feel that the Department of Veterans Affairs made a mistake or overlooked something in your claim, this option might help you receive an appropriate disability rating or benefits.
This complete guide will help you understand the VA Higher-Level Review process, including who can request this type of review, wait times in each step of the HLR process, mistakes and pitfalls claimants routinely make (and should therefore avoid), as well as actionable tips to increase your chances for a positive outcome.
What Is a VA Higher-Level Review?
In this case, a VA Higher-Level Review is an official way to appeal for veterans who disagree with the VA’s previous decision on their claim. During this thorough process, a senior claims adjudicator (often someone with decades of experience) reconsiders the initial decision and attempts to determine if any errors in procedure or fact led the VA to make its conclusion.
The Higher-Level Review prohibits the submission of any new evidence at this step, unlike a supplemental claim process. It is instead a review solely of the evidence that was in the file at the time of the original denial, without new analysis introduced by either party.
This comprehensive review can result in the following scenarios:
- Granting previously denied benefits, providing the veteran with access to entitled resources.
- An increase to the veteran’s disability rating, showing a more accurate picture of their condition.
- Fixing typos, errors, or omissions that occurred in the data processing and led to the original challenged decision, thereby ensuring a manifestly accurate and fairer outcome.
- Validation of the original decision if, upon review, it is established that the first adjudication was conducted properly according to relevant standards.
Ultimately, in broader terms, what the VA Higher-Level Review is supposed to provide for you is assurance that every applicable law, regulation, and policy was correctly and consistently applied by the Department of Veterans Affairs as it considered your claim, so you can be assured of an appropriate result — all contributing to protecting the integrity of the claims process and ensuring fair treatment.
Who Qualifies for a Higher-Level Review?
If the VA’s final decision is unfavorable to you and you disagree with it, a Higher-Level Review may be requested. This option is only available if the decision in question was issued within the past twelve months, ensuring its review process remains timely and relevant. This option may be the best choice if you believe the VA erred in its review of previously submitted evidence, and you have no new proof to provide or discuss. Importantly, you only need to submit your previous evidence when pursuing a Higher-Level Review; there is no requirement to submit new supporting documents.
This option is often utilized after decisions related to claims such as a service-connected disability, an increased rating, dependency (e.g., spousal payments), an effective date dispute, or a VA compensation benefit. Each of these areas requires careful decision-making that can significantly impact the benefits a veteran or VA beneficiary receives.
On the other hand, if you have additional medical records or evidence that were not included in your original submission, a VA Supplemental Claim may be more appropriate (and beneficial), as it allows new information and facts to be considered.
How Does the VA Higher-Level Review Process Work?
Step 1: Review Your Decision Letter
Carefully read the VA decision letter to understand why your claim was denied or why you received a lower rating than expected.
Pay close attention to:
- Evidence reviewed
- Applicable laws and regulations
- Reasons for denial
- Disability rating explanations
Identifying the specific error helps determine whether a Higher-Level Review is the right choice.
Step 2: Complete VA Form 20-0996
To request a Higher-Level Review, veterans must submit VA Form 20-0996, Decision Review Request: Higher-Level Review.
The form requires:
- Personal information
- Claim details
- Decision date
- Specific issues being appealed
Accuracy is important because mistakes can delay processing.
Step 3: Request an Informal Conference (Optional)
One valuable feature of the Higher-Level Review process is the opportunity to request an informal conference.
During this phone call, you or your representative can:
- Explain perceived errors
- Clarify misunderstandings
- Highlight overlooked evidence already in the file
While not required, an informal conference can sometimes help reviewers better understand your position.
Step 4: Senior Reviewer Examines the Claim
A more experienced VA reviewer evaluates the claim independently.
The reviewer determines whether:
- Relevant evidence was overlooked
- Regulations were incorrectly applied
- Errors affected the outcome
No new evidence can be considered during this stage.
Step 5: Receive a New Decision
After completing the review, the VA issues a new decision.
Possible outcomes include:
- Decision upheld
- Decision changed in your favor
- Duty-to-assist error identified
- Additional claim development required
How Long Does a VA Higher-Level Review Take?
A significant benefit of requesting a Higher-Level Review is the faster processing speed this forum generally provides compared to other appeal options. Many of these reviews are completed in a matter of months, though precise timelines can differ widely depending on factors such as the current workload of the region processing your claim and any unusual complexities associated with your individual review.
Factors that may impact and prolong the processing period include:
- A large number of issues or specific claims under appeal, as appealing more contested issues typically requires deeper analysis.
- The current caseload and backlog at the regional office processing your file, which can vary and either add or subtract time from the total processing speed.
- The need for further development or to procure additional evidence, including documentary records and other materials, which may be needed for a full review.
- Informal conferences between the veteran and VA, which can add time depending on the availability of hearings.
Many veterans choose this route over longer and more extensive appeal processes because it is often faster than requesting a traditional decision review, as the Higher-Level Review has become one of the most popular ways for veterans to quickly finalize their claims.
Common Reasons Veterans Request a Higher-Level Review
Incorrect Disability Rating
A disability rating for a veteran can understate the actual severity, degree, or duration of their medical problem, affecting their daily living and functioning. Example: A veteran who suffers catastrophic and disabling limitations of all mobility may receive a diagnosis tied to severe loss, yet be awarded a disability rating with much lower points than deserved, despite the full medical history and clinical support already present in their claims file. Because of this variance, the disability rating system can lead to lower compensation and benefits than warranted based on the veteran’s true extent of disability.
Evidence Was Overlooked
On other occasions, important medical records and comprehensive service treatment and personnel record entries may exist in the veteran’s file but are not adequately reviewed or reasonably weighed during initial claims development. This can result in the veteran receiving an insufficient assessment of their condition, leading to an inaccurate disability rating.
Effective Date Errors
An improper effective date may reduce the retroactive benefits or back pay that a veteran deserves, and errors related to this issue can cost veterans millions of dollars. These errors can delay access to rightful benefits for the veteran and family members, potentially resulting in financial hardship.
Misapplication of VA Regulations
At other times, the Department of Veterans Affairs misinterprets or wrongfully applies relevant VA regulations and guidelines that affect claims for disability benefits. Such a misapplication of the rules can lead to either an improper denial of benefits or a disability rating that is below what it actually should be under the law.
Practical Tips for a Successful Higher-Level Review
Gain a Deep Understanding of What the Error Really Is
Instead of simply disagreeing with the decision that was made, focus your energy on carefully identifying the specific error or oversight. Identifying the exact error will better set up your appeal. Specific, reasonable arguments, substantiated by thorough documentation and addressing targeted contention points you anticipate, are often much more persuasive and impactful than nondescript or general complaints lacking a clear target.
Structure of your Appeal
Take the time to carefully review every pertinent document and piece of evidence tied to your claim. Based on this overview, sketch out a detailed summary of the primary problem (or problems) your appeal addresses. A logically structured appeal, based on facts and highlighting the key aspects that would lead to a favorable outcome, is crucial.
Be Strategic about the Informal Conference Opportunity
When you participate in the informal conference, prepare a written set of talking points that clearly present your position. During your presentation, clearly articulate how your evidence compellingly supports your claims. Provide concrete examples of regulations or policies that may have been misinterpreted or misapplied, along with sound reasoning for why they should take a fresh view. This stage is vital because, if you have something on your mind, do not hesitate to convey it with effective communication, as that will lead to addressing your concern.
Collaborate with an Accredited Representative
Reach out for help from experts (accredited veterans service organizations, claims agents, and/or attorneys) with specialized knowledge of the VA appeals process. These representatives typically have vast knowledge and understanding, and can assist you in navigating the multifaceted system, thereby solidifying your case and improving your chances for a successful outcome.
Common Mistakes to Avoid
Submitting New Evidence
Higher-Level Review considers only the evidence already in the record and available for review. It considers only information from prior submissions and does not include any new evidence or information. Therefore, if you have new evidence that might affect the result, filing a supplemental claim is advisable, as this process allows for the submission and review of new evidence.
Missing the One-Year Deadline
Veterans, with limited exceptions, have one year from the date of the decision on their application to file a formal request or appeal. Not filing your request within this one year could severely limit or terminate options for further appeal. It is therefore critical to keep this deadline in mind; otherwise, you risk forfeiting all potential review options.
Filing the Wrong Appeal Type
If you choose the wrong type of appeal or review lane, it could unnecessarily delay your claim and prevent you from achieving a resolution. Each appeal pathway has different eligibility criteria and procedures, so it is essential to properly evaluate your particular situation before determining which option to file.
Not Reading the Decision Letter
Countless veterans who proceed to the appeal stage do so without taking the time to fully understand why their claim was denied. Sometimes the decision letter will contain critical information, detailed explanations, and clues that can guide you toward an efficient next step. A thorough reading of this letter can yield valuable insight and increase the chances of success.
When a Supplemental Claim May Be Better
In certain cases, a Higher-Level Review is not necessarily the best or most efficient approach.
If you have any of the following, it may be time to file a supplemental claim:
Novel and persuasive medical opinions not previously submitted or adequately considered;
Other treatment records that bolster the evidence of your condition or its progression;
Newly discovered service records that were missing previously or did not receive attention in earlier reviews;
Newly obtained diagnoses that represent significant alterations or transformations in your medical condition.
You should understand that no new evidence may be considered or reviewed when using the Higher-Level Review process—the evaluation will solely consider existing materials submitted previously.
Final Thoughts on VA Higher-Level Review
A VA Higher-Level Review is an invaluable and expedient approach to appeal an adverse decision of the U.S. Department of Veterans Affairs when you believe the agency made a mistake in its analysis or consideration of the evidence on file for your claim. This review process is widely known for being much speedier than many other available appeal options, thus giving veterans a chance to benefit from the review of a more experienced and senior adjudicator who can look at all evidence in their case with an open mind.
When you file a Higher-Level Review request, it is essential that you itemize and thoroughly detail the problems or disputes with your original decision letter. Finally, you need to carefully consider whether requesting a Higher-Level Review is the best and most strategic next step in your specific case. If you have an entirely new piece of evidence that was never submitted or considered, it may be better to go the supplemental claim route instead, as this path allows for the submission of additional evidence that can influence the outcome.
If you become confused or overwhelmed with the complexities inherent in pursuing a benefits appeal at any time, I strongly suggest enlisting help from an accredited veteran’s service officer, a trained claims agent, or a qualified attorney focused on veteran issues. Such professionals can prove to be of immeasurable assistance as they guide you through weighing your options and departmental processes efficiently, educating you on the process while also ensuring that each step is adhered to in accordance with appeals procedures. Additionally, you can call the VA directly or submit an online request on their website, or even work with a qualified advocate to properly file your appeal (and avoid missing deadlines) to maximize your chances of a positive review.
Frequently Asked Questions
- What is a VA Higher-Level Review?
A VA Higher-Level Review is an appeal option where a senior VA reviewer reexamines a claim decision using the evidence already in the record to determine whether an error occurred.
- Can I submit new evidence during a Higher-Level Review?
No. The reviewer can only consider evidence that existed when the original decision was made. New evidence requires a supplemental claim.
- How do I request a VA Higher-Level Review?
You must submit VA Form 20-0996 within one year of receiving the decision you want reviewed.
- How long does a VA Higher-Level Review take?
Processing times vary, but many reviews are completed within several months, depending on claim complexity and VA workload.
- What happens if my Higher-Level Review is denied?
You may still pursue other appeal options, including filing a supplemental claim with new evidence or appealing to the Board of Veterans’ Appeals.
- Is a Higher-Level Review better than a supplemental claim?
It depends on your situation. If the VA made an error using existing evidence, a Higher-Level Review may be appropriate. If you have new evidence, a supplemental claim is often the better choice.
- Can I speak directly with the reviewer?
You may request an informal conference, which allows you or your representative to discuss the case and identify possible errors in the original decision.
- Does a Higher-Level Review increase my disability rating?
It can. If the reviewer finds that the evidence supports a higher evaluation, the VA may increase your disability rating and potentially award additional back pay.
Also Read
VA Appeals Process – What You Can Expect
How to Appeal a Denied VA Disability Claim