The United States Department of Veterans Affairs (VA) passed the Veterans Appeals Improvement and Modernization Act of 2017 to give veterans additional opportunities to appeal their denied VA claims. The act implemented the following changes when it went into effect in February 2019:
- The act improved and modernized the current VA claims and appeals process.
- Provided three new review options for veterans on how to proceed when they disagree with the original decision on their VA disability claim.
- Required the VA to provide improved notification regarding its claim decisions.
- Provided an improved review system and claim resolution process.
- Ensured veterans received the earliest possible effective date for VA disability benefits after overturning an initial denial.
The Appeals Modernization Act allows veterans to choose the best review lane to get their claim for VA benefits in front of a new claims adjudicator.
Understanding Higher-Level Review for Veterans Disability Claims
With the higher-level review option, veterans can request that a different VA employee go through the review process again if the veteran feels the original reviewer made a mistake. They are allowed to submit their claim again if and when they feel that evidence exists of a clear and unmistakable error, otherwise referred to as a CUE by the BVA. Veterans cannot submit additional medical evidence for disability compensation at this stage of the review process but will have a chance later down the line.
One of three potential scenarios can happen with higher-level review claims. In the first scenario, the new claims adjudicator can overturn the previous decision based on a difference of opinion or discovery of an obvious error. The veteran will receive immediate approval for VA disability compensation in this case. The veteran will be able to save time and will have made the most of the decision review request: higher-level review.
Another possibility is that the new claims adjudicator will spot an unmistakable error or specific issues and return the VA claim to the central office for correction. The third possibility is that the new adjudicator will agree with the previous decision and reject the claim for VA disability benefits a second time.
Although the higher-level review option has only been available for two and one-half years, the veteran law firm of Hill & Ponton has noted a low favorability with rating decisions so far. One reason is that veterans cannot submit new evidence to a higher-level reviewer, and the original VA claim may not have included enough evidence in the first place. Another thing to consider is that most VA reviewers will not be keen on overturning a VA claims denial decision made by one of their peers.
The Supplemental Claim Lane Option
This particular appeal option allows veterans to submit new evidence that may impact the VA’s decision. Keep in mind that the VA has a statutory duty to assist veterans with gathering evidence and developing the claim in full. Once the VA accepts a supplemental claim, it goes into a national work queue that the VA distributes to regional offices across the country based on the date of receipt. The VA has established a goal of 125 days from the time it receives a supplemental claim until it makes a new approval or rating decision.
Veterans should keep in mind that supplemental claims do not go to a judge or to the Board of Veterans Appeals (BVA). What that means is they will not have a chance to request a hearing if they do not agree with the decision of the higher-level reviewer. However, veterans do have the entitlement to submit new evidence within 90 days sending the appealed claim through the rating decision process just as an initial claim went.
Legacy Appeals vs. Appeals Modernization Act Differences
The third review option provides three unique appeal lanes for veterans to pursue. The first is the direct review process. Veterans cannot submit additional evidence or request a hearing before the Board of Veterans Appeals. As a disclaimer, the turnaround time can be as long as one year.
The second option, also known as Lane 2 or Additional Evidence Review, allows veterans to submit additional evidence within 90 days of furnishing the VA with a Notice of Disagreement (NOD). Veterans do not receive a personal hearing/informal conference and can expect to wait longer than one year for a claim decision.
With Lane 3, AKA the Hearing Review, veterans can request a personal hearing before the Board of Veterans Appeals. They can also submit additional evidence with this review option and even be assigned a new VA adjudicator. Veterans should expect the longest wait time for a claim decision if they exercise this option.
Regardless of which appeal option veterans choose to exercise, they must submit VA Form 20-0996 to request a higher-level review of a previous VA claim decision.
Acceptable Medical Evidence When Choosing a VA Appeals Option That Allows It
Veterans who opt for an appeal lane that allows them to submit additional evidence to a decision review officer should be able to produce documentation that proves a service connection to the condition for which they want to claim VA disability benefits. Here are several types of acceptable new evidence:
- Formal diagnosis from a medical provider and relevant evidence that could overturn the prior decision.
- Proof of a medical nexus, which is an in-service event or stressor that caused or worsened an existing medical condition.
- Statement in Support of Claim, also known as VA Form 21-4138. This form allows veterans to include statements from fellow service members, family, or friends, to support their claim for VA disability benefits.
- A medical nexus letter.
- A completed disability questionnaire.
Contact Hill & Ponton for Additional Help with Veterans Claims
At Hill & Ponton, we understand that going through the long process of submitting a VA disability claim only to receive a denial of benefits is frustrating. Deciding which higher-level review process to pursue can be equally challenging. Our law firm has years of experience representing claimants for VA disability and navigating Va.gov. We invite veterans to learn more about the VA appeals system and how we can help by completing this form.
