Receiving a denial on a VA disability claim can be disheartening, especially for veterans who count on these benefits for medical care, financial stability, and overall well-being. The VA’s appeals process provides options for veterans to challenge denied claims, with Higher Level Reviews (HLRs) being one of the most efficient options to request a review. In this article, we’ll break down the essentials of an HLR, discuss how to initiate one, and explain what veterans can do to strengthen their case for a positive outcome.
What is a Higher Level Review (HLR)?
An HLR is a formal review option that allows veterans to challenge a denied claim by having a more experienced VA reviewer re-evaluate the decision. Unlike other appeal options, an HLR does not permit new evidence but focuses on reviewing the evidence and documentation initially provided. The goal is to determine whether the original decision was correctly made, giving veterans a chance for an accurate and fair reconsideration of their case.
When Should You Request a Higher Level Review?
An HLR is ideal if you believe the VA made an error in evaluating your original claim. Some situations where an HLR is recommended include:
•Incorrect application of VA rules or regulations: If you believe the VA overlooked a key detail or applied the wrong rule.
•Misinterpretation of evidence: If the VA did not fully or accurately assess the evidence you submitted.
•Insufficient justification for denial: If you feel that the reasons for the denial were not adequately explained or were arbitrary.
If you have new evidence related to your claim, an HLR may not be the best option. In such cases, a Supplemental Claim may be more suitable.
Step-by-Step Guide to Requesting an HLR
1. Review the Denial Letter Carefully
Before initiating an HLR, closely examine the VA’s denial letter to understand the reasons for denial. Identifying the specific grounds of the denial can help in crafting a well-reasoned HLR request.
2. Complete VA Form 20-0996
An HLR is initiated by submitting VA Form 20-0996, which can be filled out online through the VA’s eBenefits portal, mailed, or hand-delivered to your regional VA office. The form requires details about the decision you want to review, as well as the option to request an informal conference with the reviewer.
3. Request an Informal Conference
An informal conference is a phone conversation between you (or your representative) and the VA reviewer. This gives you an opportunity to clarify points in your claim and address any misunderstandings. Though optional, it can increase your chances of a favorable outcome, as it allows you to explain your perspective directly.
4. Submit Within One Year
It’s important to submit your HLR request within one year of the denial notice. Missing this window could prevent you from being eligible for the HLR process and require you to start the claim process anew.
What to Expect During the HLR Process
After submitting your HLR, your claim will be reviewed by a senior VA employee, typically with more experience in handling complex cases. The reviewer will focus on determining whether any errors were made in the initial decision, including checking that all evidence was appropriately assessed. HLRs often take less time than other appeal types because they do not require new evidence to be reviewed.
Key Points to Strengthen Your HLR
1. Clarify Misinterpreted Evidence
If your claim was denied based on what you believe to be a misinterpretation of evidence, make a concise statement on your form or during your informal conference. Focus on specific parts of the evidence that directly support your case and clearly address any misunderstandings.
2. Identify Procedural Errors
If the VA failed to consider certain evidence or applied the wrong regulation, outline this in your HLR request. For example, if the VA overlooked a medical diagnosis in your file, point this out in your statement and clarify its importance.
3. Provide a Timeline of Events
In some cases, a timeline can clarify the connections between your service, medical history, and current condition. This is especially useful if the denial involved a misunderstanding of your medical history or symptoms over time.
Advantages of an HLR vs. Other Appeal Options
An HLR is faster than other types of appeals since it relies on existing evidence. It also gives veterans a chance to have their claim reviewed by someone more experienced, potentially reducing the risk of the same mistakes being repeated. However, keep in mind that no new evidence can be submitted, so if you have additional documentation or medical records, a Supplemental Claim may be a better route.
Conclusion
The Higher Level Review process is an efficient way for veterans to challenge VA decisions that may contain errors or misinterpretations. By understanding the purpose of an HLR, knowing when to file, and preparing a well-supported request, veterans can maximize their chances of receiving the benefits they are entitled to. Navigating VA claims can be complex, but Veterans Valor is here to provide the guidance and support needed to advocate for the benefits our veterans deserve.
