Dealing with a VA claim denial can be frustrating, especially if you believe you submitted strong evidence to support your case. The Higher-Level Review process is one way to challenge the VA’s decision and get a second opinion. By requesting a Higher-Level Review, your claim will be reassessed by a senior VA adjudicator who was not involved in the original decision. In this article, we’ll walk you through the Higher-Level Review process, explain its benefits, and offer tips to improve your chances of success.
What Is a Higher-Level Review?
A Higher-Level Review is an option under the VA Appeals Modernization Act (AMA). It allows you to appeal your denied or unsatisfactory claim by requesting a fresh review from a more experienced claims adjudicator. Importantly, this process does not allow for new evidence to be submitted. Instead, it focuses on reviewing the existing evidence in your claim to identify errors or missed details.
When to Choose a Higher-Level Review
Higher-Level Reviews are a good option when:
- You believe the VA made an error in its initial decision.
- The VA overlooked or misinterpreted the evidence you submitted.
- Your case does not require additional evidence but could benefit from a second review.
How to File a Higher-Level Review
- Complete VA Form 20-0996: This form is required to request a Higher-Level Review. Be specific about the decision you want reviewed and include the date of the VA’s decision letter.
- Request an Informal Conference (Optional): You can request a phone call with the senior adjudicator reviewing your claim to explain your case. While not mandatory, this can be a valuable opportunity to provide additional context.
- Submit Your Form: File your completed form online, by mail, or in person at a VA Regional Office.
What Happens During the Review?
Once your request is submitted, the following steps take place:
• Assignment to a Senior Adjudicator: A higher-level VA claims reviewer, who was not part of the original decision, will evaluate your case.
• Review of Existing Evidence: The adjudicator will examine all evidence previously submitted, ensuring no errors or oversights occurred in the original decision.
• Decision Issuance: The VA will issue a new decision based on the review, either upholding the original decision, overturning it, or returning it for further development.
Key Features of the Higher-Level Review Process
• No New Evidence: You cannot submit additional evidence during a Higher-Level Review. The decision will be based solely on the evidence already in your file.
• One-Year Deadline: You must request a Higher-Level Review within one year of the date on your original decision letter.
• No Further Review by the Same Adjudicator: The person conducting your review will have no prior involvement with your case, ensuring a fresh perspective.
Benefits of a Higher-Level Review
• Fresh Perspective: Your case is reviewed by a more experienced adjudicator, increasing the likelihood of catching errors.
• Faster Resolution: Higher-Level Reviews are typically processed more quickly than other appeal options, such as the Board of Veterans’ Appeals.
• No Risk of Losing Benefits: Unlike some appeals, a Higher-Level Review will not reduce your existing benefits, even if the decision is upheld.
Common Issues Addressed in Higher-Level Reviews
Higher-Level Reviews are particularly helpful for addressing the following issues:
- Errors in applying VA regulations or policies.
- Misinterpretation of medical evidence or service records.
- Failure to consider relevant evidence that was included in the original claim.
Tips for a Successful Higher-Level Review
• Carefully Review Your Decision Letter: Before filing, review the VA’s reasoning for denying or undervaluing your claim. This will help you identify potential errors to highlight during the review.
• Request an Informal Conference: If you believe a phone discussion could clarify your case, request an informal conference to provide additional context to the reviewer.
• Seek Professional Assistance: A Veterans Service Organization (VSO) or VA-accredited representative can help you navigate the process and ensure your request is properly prepared.
Challenges to Be Aware Of
While Higher-Level Reviews can be effective, they are not without challenges:
• No New Evidence Allowed: If your claim requires additional evidence, a Supplemental Claim may be a better option.
• VA’s Discretion: The outcome depends on the reviewer’s interpretation of the evidence, which can vary.
• Limited Scope: A Higher-Level Review focuses only on the evidence in your file; it cannot address issues that require further development.
Conclusion
The Higher-Level Review process provides a valuable opportunity to challenge the VA’s decision and receive a second opinion from a more experienced adjudicator. By carefully preparing your request and considering an informal conference, you can improve your chances of a favorable outcome. If you’re unsure whether a Higher-Level Review is the right choice for your case, Veterans Valor can provide expert guidance to help you navigate the process. Contact us today to learn how we can assist you in achieving the benefits you deserve.
