How To File VA Form 20-0996: Higher Level Review
CCK Law: Our Vital Role in Veterans Law
What Is a Higher-Level Review?
Since the Veterans Appeals Improvement and Modernization Act (AMA) was implemented on February 19, 2019, veterans have the option to appeal a Department of Veterans Affairs (VA) decision through one of three lanes: Higher-Level Review (using VA Form 20-0996), Supplemental Claim, or Notice of Disagreement.
A Higher-Level Review (HLR) is an evaluation of a veteran’s current claim by a senior VA employee. Essentially, a more experienced rating specialist will review the veteran’s claim de novo (i.e., a new look) and then issue a new decision based on the same evidence of record as the prior decision. This means that veterans are not allowed to submit additional evidence in the Higher-Level Review lane.
Additionally, the higher-level reviewer may send a claim back to the prior decision-maker to correct any errors. For example, if the senior VA employee finds a duty to assist error during their review of the veteran’s claim, the claim will be sent back to the Supplemental Claim lane in order for the error to be fixed. However, if the higher-level reviewer is able to grant the maximum benefit to the veteran, they will not send the claim back.
When Should I Request a Higher-Level Review?
Filing for a higher-level review is ideal in situations where the veteran believes their claim would benefit from the judgment of a more senior-level VA employee. This might apply in situations including:
- If the veteran’s claim was denied or underrated due to a mistake or misinterpretation the original VA reviewer made (e.g., overlooking existing evidence).
- If the original VA reviewer failed to apply the law correctly, and the veteran notices this.
- If the veteran is confident that the evidence they submitted is sufficient, and that they simply need a more experienced adjudicator to review their claim, rather than additional evidence.
Veterans should strive to submit an HLR within one year of VA’s unfavorable decision, as this will let them keep the original effective date for their claim.
Are There Situations Where I Cannot Request an HLR?
Typically, veterans cannot request a higher-level review in the following circumstances:
- If they have just requested a higher-level review, but disagree with the decision the higher-level reviewer returned.
- If the Board of Veterans’ Appeals issued the decision, since they are the highest authority within VA.
- If the Court of Appeals for Veterans Claims (CAVC) issued the decision, as the Court is a separate body from VA.
What Is VA Form 20-0996?
When requesting a Higher-Level Review, veterans are required to submit VA Form 20-0996, Application for Higher-Level Review. Veterans must do so within one year of the VA rating decision they are appealing. If a veteran files for a Higher-Level Review after the one-year period, their effective date will no longer be the date of the original claim, but rather the date the Higher-Level Review form was filed.
VA uses VA Form 20-0996 to identify a veteran’s specific issues with a VA decision. It then applies this information to initiate a Higher-Level Review.
Veterans cannot submit new evidence alongside VA Form 20-0996. However, the veteran and/or their representative can speak with the reviewer over the phone (i.e., an “informal conference”) to identify errors and inform them why they believe the decision should be changed. Claimants are only allowed one informal conference for each Higher-Level Review.
Veterans can file VA Form 20-0996 Decision Review Request: Higher-Level Review online. Claimants can also download, complete, and submit the form in-person at their local VA Regional Office or mail the form to the Claims Intake Center.
How to Fill Out VA Form 20-0996 Decision Review Request: Higher-Level Review
VA Form 20-0996 contains seven sections that veterans must complete:
Section I and II: Identification Information
Section I is for the veteran’s identification information, such as their name, social security number, VA file number, date of birth, current mailing address, telephone number, and email address. If the claimant is not the veteran (e.g., a surviving spouse or dependent), they can provide their identification information in Section II.
Section III: Benefit Type
In Section III, you must check the box of the benefit type (i.e., compensation, pension/survivor benefits, life insurance, etc.) for which you are requesting a Higher-Level Review. You can only select one benefit in this section. So, if you need a Higher-Level Review for multiple benefit types, you must complete a separate VA Form 20-0996 for each one.
Section IV: Optional Informal Conference
As mentioned above, you or your accredited representative can opt into an informal conference with the higher-level reviewer. During this phone call, you or your representative can clearly identify the errors in the prior VA decision.
If you choose to have the conference, you must check the box (16A) and select the best timeframe for you or your representative to receive the call (16B) under Section IV. If your representative will speak with the higher-level reviewer, you must also provide their contact information (Box 17).
Section V: Issues for Higher-Level Review
In Section V, you must list each issue on appeal (19A) and the date of the VA decision notification letter (19B). If necessary, you may also attach extra sheets, with your name and VA file number on each additional page. Importantly, you can only list issues for the benefit type you indicated in Section III.
The following are some examples of issues a claimant may list in Section V:
- Earlier effective date for type 2 diabetes
- Service connection for bilateral hearing loss
- Entitlement to Veteran Readiness and Employment (VR&E)
- Entitlement to Dependency and Indemnity Compensation (DIC)
- Increased rating for post-traumatic stress disorder (PTSD)
Additionally, if you have an issue currently pending in the Legacy appeals system, you may list that issue in this section to request review under the AMA system, instead. This is only permitted after VA has issued a Statement of the Case (SOC) or Supplemental Statement of the Case (SSOC), and the request must generally be submitted within 60 days of that decision.
By electing Higher-Level Review for a Legacy issue, you are withdrawing that specific issue from the Legacy system. Once withdrawn, the issue cannot return to the Legacy appeals process.
For Legacy issues and for Section V as a whole, it may benefit you to enlist the help of a VA-accredited representative in order to complete the section as accurately as possible.
Section VI and VII: Certification and Signature
In Section VI, you must date and sign the form. Completion of this section is required to process the claim, unless VA Form 20-0996 is accompanied by VA Form 21-0972, Alternate Signer Certification, or Section VII is completed.
Section VII requires the name, signature, and date of a VA-authorized representative, if applicable.
How Long Does a Higher-Level Review Take?
After submitting VA Form 20-0996, you do not need to do anything unless VA sends a letter requesting more information or schedules you for a compensation and pension (C&P) exam. When the Higher-Level Review is complete, VA will mail you a decision packet with details on your case.
VA’s goal for completing a Higher-Level Review is an average of 125 days, or four to five months. However, due to VA’s ongoing backlog, your wait time could be much longer. If you request an informal conference, this period may be extended even further.
What Happens If I Disagree with the Higher-Level Reviewer’s Decision?
If a veteran disagrees with the decision of a higher-level reviewer, they cannot immediately submit another higher-level review request. Instead, if they wish to continue their appeal, they can choose either of the following appeal options available through the AMA:
- File a supplemental claim with new and relevant evidence; or
- File a Notice of Disagreement in order to appeal to the Board of Veterans’ Appeals, the highest level of review within VA.
Need Assistance with Your Higher-Level Review Appeal?
Was your disability claim denied by VA? If you are considering filing VA Form 20-0996: Higher-Level Review, Chisholm Chisholm & Kilpatrick LTD is here to help. CCK has assisted numerous veterans in securing VA benefits on appeal and may be able to help you, too. Call CCK today at 800-544-9144 to schedule a free case review.
