Once a decision is issued, you have a year to file an appeal. We urge everyone to use that option while it is available to you. After the appeal period elapses, you can continue your case but the earliest effective date is no longer protected. As a result, you could potentially miss out on substantial retroactive benefits so it is important to know the proper way to navigate the VA process. Being familiar with the process will allow you to get the most out of your case and the best chance for an increased rating.
Submitting an Appeal
The VA has an official form to submit your appeal. It is the VA Form 21-0958 and referred to as a Notice of Disagreement (NOD). Utilizing the proper form helps ensure that it will be taken as an appeal. When completing the NOD for submission, you must list out each issue. You will also need to state whether you disagree with the evaluation, effective date, service connection or another aspect. If you’re unsure, you may select more than one.
The NOD form asks for a percentage that you are seeking for the evaluation of your disability as well. This can be the tricky part. To determine your proper rating, you can review the rating sheet included in your decision. The sheet will list the diagnostic code used for each claim and you can review the criteria assigned to the given code. For example, if you have claimed sleep apnea and use a CPAP machine, your minimum rating should be 30%.
It can be difficult to pin down whether a decision is correct so it’s best to appeal everything and ask for 100%. You can always withdraw certain claims later but if you decide to add more after the appeal period, it puts you back at the starting line with those claims. And no one wants to go through this process more than once.
Filing a New Claim
If a new claim does need to be filed, the VA Form 21-526b allows you to file for an increased rating. This can be confusing if you are not aware of the appeal option.
The claim form is better to file if you are correctly awarded 50% for your back but it has worsened significantly five years later. At that time, you could file a new claim for a higher evaluation. Additionally, if you have developed other issues as a result of your back, you may be eligible to file for secondary claims.
The 526b form also gives the option of reopening a claim. If you were denied service connection for a condition and never appealed, you can request to reopen that claim. However, you must have new and material evidence. You have to give them a reason to change their mind and show why their original decision may have been incorrect.
Request for Reconsideration
The last option is called a request for reconsideration. A request for reconsideration is not the same thing as an appeal. While asking the VA to reconsider may sound like an appeal, because you disagree with the decision, you must clarify that you DISAGREE and are APPEALING the decision.
A request for reconsideration can be faster, which is tempting, but an appeal is still the best option in most cases. Under reconsideration, the same person who issued the unfavorable decision will be reviewing your case again. So it may be faster but can often just be a fast track to another denial. You also could lose your appeal rights because reconsideration requests do not suspend the appeal period. It can be an either/or as you may end up outside of the appeal period by the time the reconsideration process has been completed.
There are certain instances though when reconsiderations can be beneficial. The VA will deny claims that were not evaluated at a Compensation and Pension examination. In the event that you missed your examination and received a denial, asking the VA to reconsider their decision could lead to a new examination for proper case development. Hopefully, you will then receive a favorable outcome once they have the medical evaluation information on file.
Even though reconsideration can be useful, it can be crucial to your case to submit an appeal. In general, claims for increased ratings and reconsideration requests should not be used in lieu of appeals. Submitting an appeal to an initial rating decision can also help because it is the standard step in the process. This allows you to verify proper procedure is taken at each level. By following the claim steps, it makes it easier to determine the next stage and what is needed to continue your case for a favorable outcome.
All in all, if you are ever unsure of whether your decision is correct, appeal first and ask questions later.