When the VA denies your disability claim or assigns a lower rating than expected, you have options. The Higher Level Review (HLR) process offers Veterans a way to challenge VA decisions without submitting new evidence. This guide explains how the VA Higher Level Review works and what to expect during the process.
Understanding the VA Higher Level Review Process
The VA Higher Level Review is part of the VA’s streamlined appeals system, established under the Veterans Appeals Improvement and Modernization Act of 2017 (AMA). A Higher Level Review allows a senior VA claims adjudicator to review your existing claim. This reviewer has more experience than the initial claims processor and will take a fresh look at your case using the evidence already in your file.
Key Elements of the VA Higher Level Review Process
- No New Evidence Reviewed: The decision is based solely on the evidence available in your claim’s record at the time of the initial VA decision.
- Experienced Decision Review Officers (DROs): The review is conducted by a senior, more experienced adjudicator who wasn’t involved in the original decision.
- “De Novo” Review: The adjudicator starts fresh, analyzing the case as if no prior decision was made.
Eligible Veterans are usually those who recently received a decision on their VA disability claim and feel that the VA made an error in how it reviewed the evidence or applied the law.
How to Determine Eligibility:
- You’ve received a decision on your VA disability claim.
- You don’t have any new evidence to add.
- You believe a mistake was made during the evaluation of your claim.
Benefits of Choosing the VA Higher Level Review Process
Why should Veterans choose the HLR process over traditional appeal methods? Here are some of the benefits:
1. Faster Decision-Making
Compared to traditional Board of Veterans’ Appeals (BVA) cases, HLRs are typically resolved more quickly. Timelines may vary, but many Veterans receive decisions in under 125 days.
2. Fresh Perspective
Since a DRO reviews your case “de novo,” the fresh analysis often results in more accurate decisions, especially in cases where errors in judgment occurred initially.
3. No Need for New Evidence
If gathering new evidence seems daunting or unnecessary, the HLR process limits complications by relying solely on what’s already in your file.
Real Life Example:
John, a Marine Corps Veteran, received a 30% rating for PTSD but felt it didn’t accurately reflect his condition. After submitting a Higher Level Review request and participating in an informal conference call with the adjudicator, his condition was reassessed and adjusted to a 50% rating—giving him access to greater monthly compensation and benefits.
Step-by-Step Guide to Filing for Higher Level Review
Follow this guide to ensure your HLR request is processed smoothly:
Step 1: Fill Out VA Form 20-0996
Start by completing the Decision Review Request: Higher Level Review (VA Form 20-0996). Ensure all required details, such as the decision date and issues you want reviewed, are provided.
Step 2: Identify Errors or Concerns
Be specific about why you disagree with the initial decision. Use clear reasoning—for example, incorrect application of regulations or failure to consider key evidence.
Step 3: Request an Informal Conference (Optional)
You can opt for an informal conference, where you’ll have the opportunity to speak directly to the DRO assigned to your review. This can be useful to clarify your position and address any apparent misunderstandings in the initial claim.
Step 4: Submit the Form
Mail the completed form to the VA office handling your claim or submit it online through the VA’s Decision Review Request tool. Ensure you receive confirmation of submission.
Step 5: Await Your Decision
Patience is important. While this process is faster than others, it can still take several weeks, so keep track of timelines and contact the VA if needed.
Common Mistakes to Avoid in the HLR Process
To maximize your chances of a favorable outcome, steer clear of these common errors:
1. Failing to Review Your Initial Decision
Not understanding the specifics of why your claim was denied could lead to an ineffective appeal. Always review your initial VA decision carefully to identify errors.
2. Submitting New Evidence
Submitting new evidence is not allowed in HLR. If you have new information, you should pursue a Supplemental Claim instead.
3. Not Being Specific
General disagreements without clear reasoning reduce the effectiveness of your appeal. Describe exactly why you believe the VA made an error.
4. Missing Deadlines
You must submit your HLR request within one year of the date on your VA decision letter. Missing this deadline could limit your options.
Reviewing the Decision
Once the HLR process is complete, you’ll receive a VA decision letter outlining one of three outcomes:
- Claim Approved: If the DRO identifies that the initial decision was indeed wrong, your claim may be granted with a revised rating or effective date.
- Claim Denied: If the DRO confirms the initial decision, you can explore alternative appeal paths like filing a Notice of Disagreement (NOD) for a BVA review.
- Partial Approval: If some issues are resolved but others remain denied, you can proceed with filing appeals for the unresolved matters.
Empowering Your Benefits Journey
Understanding the VA Higher Level Review process is an important step for Veterans looking to correct claim errors and secure the benefits they deserve. By following the steps above, avoiding common pitfalls, and submitting a well-prepared application, you’ll greatly enhance your chances of a favorable outcome.
Frequently Asked Questions
How long does the VA Higher Level Review process take?
Most VA Higher Level Reviews are completed within 125 days. However, complex cases or those requiring additional review may take longer. The process is typically faster than traditional Board appeals.
Can I submit new evidence during a Higher Level Review?
No. The VA Higher Level Review process only considers evidence that was in your file at the time of the initial decision. If you have new evidence, you should file a Supplemental Claim instead.
Is there a deadline to file for Higher Level Review?
Yes. You must file your Higher Level Review request within one year of the date on your VA decision letter. Missing this deadline may require you to file a new claim.
Get Expert Guidance Today
Don’t leave your claims to chance—ensure they’re done the right way, the first time. Contact Veteran Ratings today for comprehensive guidance with your benefits by filling out the form below, or giving us a call at (619) 916-4652. Our team is here to guide you through the process, avoid unnecessary delays, and help you secure the benefits you’ve earned.
