An experienced VA benefits advocate can be your guide through the complex appeals process. Any veteran, surviving loved one of a deceased veteran, or others with a claim for VA disability benefits has the right to appeal a VA benefits claim decision they are not satisfied with. However, the U.S. Department of Veterans Affairs (VA) states in multiple publications that VA’s appeal process is “complex,” “non-linear” and “unique” from other federal and judicial processes.
Getting help is strongly recommended for anyone appealing a benefits-related VA decision. Veterans disability claims advocates have the knowledge and experience necessary to help you through a VA disability benefits appeal. They know VA procedures and what its bureaucracy requires.
Reasons to Request a VA Decision Review
A seasoned advocate can build your claim file with additional evidence to increase your chances of success on appeal. The two most common reasons people appeal VA benefit decisions are:
- VA officials denied benefits for a disability you believe should be service-connected.
- You believe your disability rating should be higher than VA rated it.
For most VA decisions, you have one year from the date listed on the decision letter to file a Decision Review Request.
When to File a Decision Review Request
If you have received one of the following decision types, you typically have one year to file a Decision Review Request:
- Initial Claim Decision
- Supplemental Claim Decision
- Higher-Level Review Decision
However, if the decision that you have received is a Statement of the Case, your time limit to file an appeal is generally limited to 60 days. However, if you are still within one year of the Notification Letter for the Rating Decision that you appealed, then you generally have one year from the date of that Notification Letter to file a response to the Statement of the Case.
If it has been more than one year since the Notification Letter for the Rating Decision that you appealed, the time limit to respond to the Statement of the Case is generally only 60 days.
These deadlines can be very confusing—an advocate can explain them in the simplest possible terms and apply them to your case.
You’re Having Trouble With a VA Disability Claim—What Now?
If your VA disability claim hasn’t gone how you’d like it to, you can hire an advocate to help with your appeal. There are several benefits of hiring an advocate to help with your claim.
When you trust an advocate to help with your claim, you:
- Allow yourself to focus fully on your health: Dealing with a VA disability claim may get in the way of your recovery, as well as other responsibilities. When you let an advocate take over the most important aspects of your claim, you may free up time and energy to direct towards your recovery. Whether you need treatment, rest, rehabilitation, or a combination of these, hiring an advocate can give you the space you need.
- Get the help of a seasoned advocate: Experience always helps when it comes to disability claims. The advocate you choose should have ample experience helping veterans with their disability claims. Your advocate will have training that could help with the administrative aspects of your claim.
- Gain a second set of eyes: Errors in your appeal can be the downfall of your benefits claim. An advocate represents a second set of eyes to spot any possible flaws in the case.
- Get access to the resources that an advocate offers: Clients can bet that their advocate will utilize all available resources to secure a positive outcome. Such resources may include investigators, experts, and support staff. Additionally, an advocate may have easy access to medical professionals.
Still, the benefits you receive from hiring an advocate depend on which advocate you choose.
How to File an AMA VA Disability Appeal
Under the Appeals Improvement and Modernization Act (AMA), there are three different appeal lanes to consider for your AMA appeal:
- Supplemental Claim Lane (VA Form 20-0995 is required)
- Higher-Level Review Lane (VA Form 20-0996 is required)
- Board of Veterans’ Appeals (BVA) Notice of Disagreement Lane (VA Form 10182 is required)
To decide which of the above options you should file, you first must determine which type of decision you have received.
Choosing a Decision Review Lane
Did you receive an Initial Claim Level Decision, a Supplemental Claim Decision, or a Higher-Level Review Decision?
- If you have received an AMA Initial Claim Level Rating Decision, you can file a Decision Review Request into any of the three appeal lanes: Supplemental Claim Lane, Higher-Level Review Lane, or BVA Lane.
- If you have received an AMA Supplemental Claim Rating Decision, you can file a Decision Review Request into the Supplemental Claim Lane, Higher-Level Review Lane, or BVA Lane.
- If you have received an AMA Higher-Level Review Rating Decision, your only two options for an appeal are the Supplemental Claim Lane and the BVA Lane. You cannot generally appeal an AMA Higher-Level Review Decision into Higher-Level Review.
Keep in mind that under AMA, VA is also allowing anyone that receives a Legacy Statement of the Case (SOC) or a Supplemental Statement of the Case (SSOC) to opt their case into the AMA system. To do this, you can file a Decision Review Request into any of the three appeal lanes: Supplemental Claim Lane, Higher-Level Review Lane, or BVA Lane.
However, you must file the appropriate forms to opt your case into AMA within the appeal window for the Statement of the Case as outlined above. Or, if you have received an SSOC, you must file your forms within 30 days of the Notification Letter that accompanied the SSOC.
Note: Even though you have a limited amount of time to file an appeal, getting a decision on your appeal can take months or years.
How Does Each AMA Appeal Lane Differ?
Each of the three AMA appeal lanes have different attributes.
Supplemental Claim Lane
In this lane, VA will re-adjudicate your case if new and relevant evidence is presented or identified when you submit the Supplemental Claim request. VA may assist you in gathering new and relevant evidence—this is part of VA’s Duty to Assist.
Higher-Level Review Lane
In this lane, VA will not consider any new evidence, although there is an option for a one-time telephonic conference with the Higher-Level Reviewer. The Higher-Level Reviewer will conduct a de novo review of the evidence and has the authority to come to a different decision than the prior adjudicator.
If the Higher-Level Reviewer determines that there was a Duty to Assist error in the prior decision, the case will be returned to the lower level for correction and the issuance of a new decision.
In this lane, the claimant has three choices for which docket they want to choose:
- BVA Evidence-Only Docket: With this option, the veteran can submit additional evidence at the time of the BVA Notice of Disagreement (NOD) filing or within 90 days of submitting the NOD.
- BVA Direct Docket: With this option, the veteran cannot submit any new evidence and the BVA will issue a decision based on the evidence that was of record at the time of the initial decision. The advantage to filing a BVA NOD on the Direct Docket is receiving a faster decision from the Board.
- BVA Hearing Docket: With this option, the veteran will have an opportunity to testify at a hearing before the BVA. They’ll also have an opportunity to submit evidence at the hearing or within 90 days following the hearing.
What to Seek in an Advocate for Your Disability Claim
Once you’ve decided to accept help with your VA decision review, you must answer an important question: which advocate should I choose?
Some advocates specialize in matters of veterans benefits—this is the sort of advocate that you should seek for your case. Advocates who specialize in VA disability issues will:
- Have relevant experience: You won’t have to worry that your advocate is out of their depth. In fact, your advocate may have useful experience with VA disability claims and decision reviews that you don’t possess.
- Understand the challenges of being a disabled veteran: When an advocate works regularly with disabled veterans, they cannot help but learn about the challenges of being a disabled vet. Some advocates are veterans who have dealt with disabilities, and this creates a rare form of empathy. When your advocate understands what you’re going through, they may make a deeper investment in your appeal.
- Be able to deal effectively with VA representatives: Though dealing with VA matters isn’t always easy, having extensive experience can only help the process.
Don’t wait to get help. The sooner you retain the services of an experienced advocate, the sooner you may be able to relax as your advocate gets to work.
Start Your VA Disability Benefits Claim Appeal Today
The backlog of disabled veterans’ claims and appeals pending with VA makes it important that you start the decision review process as soon as possible. Contact an advocate today to start the work on your appeal of a faulty VA benefits decision. A veterans claims advocate can make sure your appeal makes a clear and persuasive case from the start.
The goal is to obtain all the money you have coming to you through VA disability benefits and resolve your claim as fast as possible. Remember that appealing adverse decisions from VA is time-sensitive, and each decision comes with an appeal deadline. Circumstances permitting, your advocate can make sure you do not miss your deadline.
Don’t go it alone. Don’t waste time. Call for a free consultation today.