THE ULTIMATE GUIDE: Navigating the VA Disability Appeals Process
VA disability benefits can be a lifeline for a veteran whose ability to earn a living is limited by a service-connected medical condition, or who requires extensive medical care for that condition. A denial or other negative determination can be devastating. You probably know that a denial, the assignment of an inappropriately low disability rating, or a determination that you don’t meet a classification such as TDIU isn’t set in stone. But, if you’re like most veterans, you probably don’t fully understand the options or how to choose the path toward fighting for your benefits such as the appeals process and other options.
Here’s what you need to know.
VA Disability Benefits
The first step toward understanding how to appeal a denial or other negative VA disability determination is to understand the issues associated with a VA disability claim. VA disability benefits are generally available to veterans who are currently affected by a medical condition that is connected to their military service. The amount of compensation available to a veteran who meets these conditions depends largely on the VA disability rating assigned.
It’s up to the veteran to show that they suffer from the medical condition or conditions they’re seeking VA disability benefits for and that the condition is service-connected. The claim will be denied if the VA decides the veteran has failed to establish either of those things. When a claim is denied, the decision letter the veteran receives will explain the reasons for the denial.
If you’ve received a denial, it doesn’t necessarily mean you won’t get benefits. It does mean that the next move is yours. But, it may be unclear what you should do next. That’s because the VA disability appeals process is actually three separate processes.
Three Types of VA Disability Appeals
About five years ago, the VA “modernized” its appeals process. The changes are intended to streamline the process, but the options can be confusing for many veterans. That’s because the different paths are based more on what you want to happen next than on something clear-cut like the type of denial. For example, if the VA denied your claim because you failed to establish that your condition was service-connected, you might use any of the three types of appeal. That decision will depend largely on what you believe went wrong.
That’s further complicated by the fact that you may not be able to tell what the missing ingredient was in your claim. That’s one reason it’s a good idea to get help from an experienced VA disability benefits advocate as early in the process as possible. If you’ve already received a denial, you should consider hiring an advocate before you begin the VA disability appeals process.
Higher Level Review
For many veterans, higher level review may be the quickest and easiest route to appealing a VA disability benefits determination. You have up to one year after a denial to request a higher-level review, but it’s generally in your best interest not to delay. The VA aims to complete the higher-level review process within 125 days, but the actual timeline may be shorter or longer. In particular, the process may take longer if you request an informal conference as part of the review.
When you request a higher-level review, a higher-level decision-maker will review your file. The higher level reviewer may change the determination if they find an error in the original decision-making process or determination. They may also overrule the original decision-maker simply because they don’t agree. You can’t submit new evidence for a higher-level review, but you do have the option of submitting a letter or statement explaining why you believe the determination was wrong.
Supplemental Claims
“Supplemental claim” may sound like a fresh kind of claim–perhaps a claim for an additional condition when you already have a VA disability rating. But, that’s not what it means. It’s actually one of the VA disability appeals options.
You can file a supplemental claim if your claim was denied and you have new and relevant evidence you would like the VA to consider. The new evidence could relate to you, such as new medical test results, or could be new evidence that supports a service connection. Or, it could be a change in VA standards, like the new presumptive conditions added for certain veterans with the passage of the PACT Act. The average time for the VA to decide on a supplemental claim is just over 131 days. But, it may be longer if they request additional information from you or send you for a medical exam.
Board Appeals
A board appeal is generally the most complex path in the VA disability appeals system. You can proceed to a board appeal directly from denial of an initial claim or supplemental claim, or you can request a board appeal after a higher-level reviewer decides against you.
There are actually three different types of board appeals. One is similar to a higher-level review and involves a Veterans Law Judge reviewing your appeal and making a decision on the record. There is no hearing and you cannot submit new evidence. For this type of board appeal, the VA says it typically takes about one year to receive a determination.
Another is evidence submission. An evidence submission appeal is similar to direct review, except that you have the opportunity to submit new evidence for the Veterans Law Judge to consider along with your existing file. The typical timeline for a decision on an evidence submission appeal is about 18 months.
Finally, you may request a hearing before a Veterans Law Judge. You may submit new evidence at the hearing, and you’ll also have a short time after the hearing to provide additional evidence. The hearing may be conducted through video conferencing from your home, video conferencing from a VA location in your area, or live in Washington, DC. This process can take two years or more.
You Don’t Have to Figure Out Your VA Appeal Alone
Choosing the best VA disability appeals channel for your situation matters. So does ensuring that you provide the right kind of documentation–if any–needed for your type of appeal. At Disabled Vets, we know that the process can be daunting. Our advocates have extensive experience with all appeals paths and know how to help you put together the strongest appeal possible. To learn more about how we can help, call us today at 888-373-4722 or fill out our contact form here.
