Veterans (VA) Appeals Reform: Higher-Level Review
What is the Higher-Level Review Lane?
By opting in to the higher-level review lane under Appeals Reform, veterans are requesting that the Regional Office issue another decision based on a higher level of review. This review will be conducted by a more experienced rating specialist who did not participate in making the prior decision. Higher-level reviewers are also generally located in a different office than the adjudicator who issued the prior decision. The higher-level reviewer will evaluate veterans’ claims de novo (i.e. new look) and then issue another decision based on the same evidence of record on which the prior decision was made. This means that veterans are not allowed to submit additional evidence in the higher-level review lane.
The higher-level reviewer has the ability to issue a new decision, or send it back to the prior decision-maker to correct any errors they find. For example, if the higher-level reviewer finds a duty to assist error during their review of the veteran’s claim, the claim will be sent back into the Supplemental Claim lane in order for the errors to be fixed. However, the higher-level reviewer will not send the claim back in this case if they can otherwise grant the maximum benefit to the veteran.
How to File for Higher-Level Review
When filing for higher-level review, veterans must make sure to do so within one year of the decision they are appealing. If a veteran files for higher-level review after that one-year period, then his or her effective date will no longer be the date of the underlying claim, but rather the date the appeal for higher-level review was filed. Under Appeals Reform, veterans will be required to submit VA Form 20-0996, Application for Higher-Level Review, in order to request a higher-level review of a VA decision. VA believes this form is necessary to identify the issues that a claimant is dissatisfied with and then use that information to initiate a higher-level review by an agency adjudicator.
A complete request using this form, whether it is submitted on paper or electronically, meets the following requirements:
- Name of the claimant (and relationship to the veteran if applicable)
- Signature of the claimant
- Specify the date of the underlying decision for which review is requested and specify the issues for which review is requested
- Received within one year of issuance of notice of the decision on appeal
VA will notify claimants and/or representatives of incomplete requests for higher-level review. If a complete request is submitted within 60 days of notification, VA will consider it filed as of the date VA received the incomplete request form. Veterans can also request an informal conference with a higher-level reviewer in which they can point out any specific errors they believe VA made in their prior decision. However, veterans cannot introduce any new evidence or facts during this informal conference.
Differences Between Higher-Level Review and Supplemental Claims
The main difference between the higher-level review lane and the supplemental claim lane involves the submission of evidence. As mentioned above, veterans are not allowed to submit additional evidence during higher-level review, whereas veterans are required to submit new and relevant evidence with their supplemental claims. Yet another important distinction involves the types of decisions eligible for appeal under each lane. Namely, supplemental claims can be filed after any adjudicative action including Rating Decisions, Board decisions, and CAVC decisions. However, higher-level review is unavailable following a Board decision, because the Board is the highest level of review within VA. Similarly, higher-level review is unavailable following a CAVC decision, as it is not part of VA. Nonetheless, a veteran can request higher-level review following an unfavorable decision from a supplemental claim. If this request occurs within the one-year period following the date VA issued the decision being reviewed, the effective date will be preserved.
- RAMP and Appeals Reform Updates
- What is the VA Disability Appeals Success Rate for Veterans?
- VA Appeals Reform Deadlines
- Is VA’s New AMA Appeals System Better for Veterans? It Depends.
- How Long VA Appeals Process Can Take – Average Appeal Times for Disability Claims
- Can I Opt-in to Appeals Reform Once It’s Enacted?
- Why Did the VA Create the Rapid Appeals Modernization Program (RAMP)?
- What Is the Difference Between the Higher-Level Review Lane and the Supplemental Claim Lane?
- Once I Join, Can I Opt Out of the Rapid Appeals Modernization Program (RAMP)?
- Who is Eligible for the Rapid Appeals Modernization Program (RAMP)?
- VA Appeals Reform is HERE (February 19, 2019)
- The New VA Appeals System, Explained
- The Board of Veterans’ Appeals Explained
- Revisiting the Rapid Appeals Modernization Program (RAMP)
- VA Claims and Appeals Backlog (Dec. 2018 Update)
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