Editor’s note: This article is the second in a series of two.
By Larry Dandridge
The VA webpage “VA Decision Reviews and Appeals” at https://www.va.gov/decision-reviews/ provides detailed information on what a veteran should do if they disagree with a VA benefit or claim decision.
The legacy VA appeals process has changed to the decision review process. If you disagree with a VA benefit or claim decision, you can choose from three decision review options (Supplemental Claim, Higher-Level Review, or Board Appeal) to continue your case. If you are not satisfied with the results of the first option you choose, you can try another eligible option. If you disagree with a VA medical decision, you can request a Clinical Appeal.
Use a VSO and, if needed, a VA accredited attorney. Veterans should use a VA-accredited Veterans Servcie Officer (VSO) to help them file an appeal. If the VSO recommends you do so or you believe you need more help, you should use a VA-accredited attorney to help you with complicated appeals. An accredited attorney, claims agent, or VSO can help you request a decision review. VSO services are free.
How to request a decision review
The VA webpage “VA Decision Reviews and Appeals” provides details on requesting a decision review and links to:
- Decision review option: Supplemental Claims: According to https://bit.ly/3cT4sQM you can file a Supplemental Claim if you have new and relevant evidence the VA didn’t have when the VA reviewed your case.
- Decision review option — Higher-Level Reviews: According to https://bit.ly/4aSUSqA, you can ask for a higher-level reviewer to review your case. You cannot submit new evidence with a Higher-Level Review.
- Decision review option — Board Appeals: According to https://bit.ly/4aSJcE2, you can appeal to the Board of Veterans’ Appeals and have a Veterans Law Judge review your case.
- Clinical Appeals of Medical Treatment Decisions: According to https://bit.ly/4dk4xGR, you can file a Clinical Appeal to request a review of a decision that your VA care team made about your care.
- Family caregiver program decision reviews and appeals: According to https://bit.ly/40WB3Ki, if you disagree with the VA decision on your Program of Comprehensive Assistance for Family Caregivers application, you have options to appeal or request a review of the decision. Your options depend on the date your PCAFC decision was issued.
- Contested claims: According to https://bit.ly/3QdmH3b, A contested claim is when you and someone else are claiming a benefit that only one person can claim. You have 60 days to appeal to a Veterans Law Judge at the Board of Veterans’ Appeals in Washington, D.C.
- Insurance claims: According to https://bit.ly/3QdGi3q, if you disagree with a VA decision on an insurance claim, you can choose from three decision review options. You can file a Supplemental Claim, ask for a Higher-Level Review, or request a Board Appeal.
- Fiduciary claims: According to https://bit.ly/40LljK8, if you disagree with a VA decision on a fiduciary claim, you can choose from three decision review options. You can file a Supplemental Claim, ask for a Higher-Level Review, or request a Board Appeal.
How to manage your decision reviews and appeals
The VA webpage “VA Decision Reviews and Appeals” at https://bit.ly/4dk4xGR provides details on requesting a decision review and links to:
- The VA webpage “Check your VA claim, decision review, or appeal status” at https://bit.ly/3WTxXW8, explains how to check the status of certain VA claims, decision reviews, or appeals online. Veterans can use the online tool to check the status of a claim, decision review, or appeal for these types of benefits: (1.) Disability compensation (including claims based on special needs like an automobile or clothing allowance), (2.) Veterans or Survivors Pension benefits, (3.) Special monthly compensation (such as Aid and Attendance), (4) Dependency and Indemnity Compensation, (5.) Burial allowance to help pay for a Veteran’s burial and funeral expenses, (6.) Specially Adapted Housing or Special Housing Adaptation grant. You can also use the online tool to check the status of (1.) Requests to add or remove dependents and (2.) Requests for approval of school attendance for dependent children.
- Healthcare Claims, decision reviews, and appeals. For health care-related claims, decision reviews, and appeals, veterans should check the information on their decision letter to find out how to check the status.
- The VA webpage “Manage a legacy VA appeal” at https://bit.ly/3WX6F1b, applies to appeals for decisions dated before February 19, 2019. VA no longer accepts new appeals through the legacy appeal process.
More information and resources
More information and resources about VA decision reviews and appeals are found at:
· The VA webpage “Choosing a decision review option” at https://bit.ly/417KUOP. This webpage will help you to find out which option is right for you.
· The VA webpage “Decision reviews Frequently Asked Questions (FAQs)” at https://bit.ly/3EHIAoM provides answers to commonly asked questions about decision reviews.
- The VA webpage “After you request a decision review (What should you do while you wait)” at https://bit.ly/42U0K0H. When your review is complete, the VA will mail you a decision packet that includes details about the decision on your case. You do not need to do anything while you wait, unless the VA sends you a letter asking for more information. If the VA schedules any exams for you, be sure not to miss them. If you requested a decision review and have not heard back from VA yet, please do not request another review. Call VA at 800-827-1000 (TTY: 711).
· The VA webpage “Manage (appeal) your VA debt for benefit overpayments and copay bills” at https://bit.ly/4coewcX. This page will explain how you can review your current VA benefit debt or copay bill balances online. and find out how to make payments or request help.
- The VA webpage “VBA Appeals Modernization” at https://bit.ly/3CKT4TQ explains The Veteran Appeals Improvement and Modernization Act of 2017,which became law on August 23, 2017 (Pub L. 115-55). It is also known as the Appeals Modernization Act (AMA). Read the law at https://bit.ly/4gDQUDx.
The bottom line
Appeals can be complex. Veterans who receive an initial claim decision that they disagree with should ask a VA-accredited VSO or a VA-accredited Attorney or claims Agent to help them appeal. Veterans can find S.C. County VSOs at https://bit.ly/3qbLVSL. Find Georgia VSOs at https://bit.ly/44KMVA7. N.C. County Department of Military and Veteran Affairs Veterans Benefits Specialists and N.C. County VSOs can be found at https://bit.ly/4ghZqHW.
Larry Dandridge is a Vietnam War wounded warrior, disabled veteran, ex-Enlisted Infantryman, ex-Warrant Officer Pilot, and retired Lt. Colonel. He is a past Veterans Service Officer, a Patient Adviser at his local VA Medical Center, a Fisher House Charleston Good Will Ambassador, and the past VP for Veteran Affairs for the local Army Association and Military Officer Association Chapters. Larry is also the author of the award-winning book Blades of Thunder (Book One) and a contributing freelance writer with the Island News. Contact him at LDandridge@earthlink.net or 843-276-7164.
