Correcting Errors – The VA Higher Level Review Process

We have been very surprised over the past year at the number of people who have come to the website following the link for the article on Correcting Errors with a  Higher Level Review. We wanted to revisit this and add to the subject.

A disability claim is not the only claim that the VA may disapprove. It can disapprove pension and survivor benefits, life insurance benefits, medical and health care benefits, and the Program of Comprehensive Assistance for Family Caregivers benefits, along with other VA benefits. It is important to note that ALL of these can be submitted for a higher level review if you feel that the VA did something wrong in deciding the case.

Several of the procedures are the same for filing for a higher level review but currently there are some differences. Remember, the only claim that can be filed using the VA online Higher Level Review form is a claim for disability compensations.

For healthcare claims, the instructions to file an appeal will be with the denial letter. Follow those instructions to file the higher level review.

For other claim types (PCAFC, life insurance, pension, etc), download the VA Form 20-0996, fill it out, and mail it to the correct processing center.

List of Processing Centers

Once you file the request, be prepared for a 4-5 month wait. That is how long it will take for the Senior Reviewer to examine the case, and that is if you do not want an informal conference. Remember, No New Evidence can be submitted with a request for higher level review. The senior rater will disregard anything done on the case before and take it from the very beginning so they are not influenced by the prior denial.

If you want to have an informal conference with your senior rater, you can. Be aware that this will extend the length of time  for the review. Also be aware that you cannot introduce new evidence. The informal review is a chance for you to talk with the senior rater and explain why you feel the VA made an error in their handling of your case.

In filling out the form, either online or the paper form, you will be asked to list the VA decisions you disagree with and the date of the decision. That will all be found in your letter from the VA. Before you fill out the form, sit down and examine the letter carefully to decide what about the decision you disagree with so that you can articulate it on the form.

Once the form is submitted, you simply have to wait. In the meantime, if the VA sends you a letter requesting more information, send it as quickly as you can. If you get a notice that the VA has scheduled you for another medical exam, be sure and keep the appointment. Failure to do these things can result in the case being denied again.

If the case is denied by the senior rater, you are still not finished with it. You have the option of appealing to the Board of Veteran Appeals, or filing a supplemental claim. As long as either is filed with a year of the denial, the case remains active and you retain your original claim date.
If you have any questions, please let us know at info@nwavet.org, or feel free to drop questions and/or comments below in the comment section.