When VA claims evaluators do not see enough evidence to prove an injury or condition resulted from a veteran’s military service, they can deny a claim for disability benefits. To appeal a claim denied after Feb. 19, 2019, veterans can request a higher-level review, submit a supplemental claim, or request an appeal with the Board of Veterans’ Appeals by filing a Notice of Disagreement. Decisions dated prior to Feb. 19, 2019, that are still in the appeals process may still be in the legacy system.
Talk to Us About Your Claim:
(812) 426-7200
In this article about what to do if your VA claim is denied:
Why VA disability claims are denied
While each claim is different, here are some common reasons a veteran may be denied VA disability benefits.
VA disability claims denied due to issues with evidence
First, the VA may claim the veteran’s condition or injury was not service-connected. In this case, the type or amount of evidence submitted did not meet the VA’s standard of proof—the requirement that the evidence must show it was “at least likely as not” that the disability resulted from military service.
If the denied claim was for total disability based on individual unemployability (TDIU), the VA might claim there was insufficient evidence to prove the disability prevents the veteran from working.
VA disability claims denied due to medical issues
The VA may deny disability claims if the veteran does not have a formal medical diagnosis for the disability.
The claim can also be denied if the veteran did not attend a compensation and pension (C&P) exam set up by the VA. These C&P exams provide the VA with a medical evaluation of the veteran’s mental or physical disabilities to help them determine connection to military service and compensation level for disability claims.
VA disability claims denied due to VA errors
The VA can make errors and procedural mistakes, too. For example, one issue you could see is the VA’s failure to consider the evidence submitted with the claim.
The VA sometimes also incorrectly applies ratings criteria. The VA uses the Schedule for Rating Disabilities in the Code of Federal Regulations to determine the veteran’s schedular rating, which then determines their approval or denial and compensation. Sometimes the VA may issue a lower rating than the veteran’s symptoms merit.
VA disability claims denied due to application errors
Applying for disability compensation can be confusing, sometimes leading veterans to submit the wrong form with their application. Consider taking advantage of the help offered by VA disability lawyers to avoid errors in the initial application process. The experienced attorneys at Woods and Woods offer veterans free consultations on their VA disability claims.
What to do after your VA disability claim is denied
If you get a decision letter stating that your VA disability claim was denied, your next step is to decide if you want to appeal the decision.
If you want to file an appeal, you’ll next decide which process you will use. There are three different ways to appeal a disability benefits decision, each with advantages for different situations.
Note, this guide applies to all denial decisions received after Feb. 19, 2019. Decisions made prior to Feb. 19, 2019, are currently in the legacy appeals process or are past the deadline to appeal.
At this time, it’s also a great idea to consider getting additional legal help to appeal the decision. A VA-accredited disability lawyer can help appealing veterans choose the process that will most likely result in their success. They also can help choose the appeal path that will preserve your earliest effective date and, as a result, maximize your opportunity for back pay.
Help with your VA appeal: What to do next
There are three different ways to appeal a denied VA claim. Below we outline the forms needed, deadlines, and evidence requirements, and we explain the process for each different approach.
#1 Appealing a denied VA claim by requesting a higher-level review
Forms needed: VA 20-0996
Deadline to appeal: 1 year from the date on the decision letter
Time to decision: An average of 4-5 months, as of this writing
New evidence requirement: No new evidence is allowed
When the VA receives a request for a higher-level review, the case is given to a senior claims adjudicator for a new review. The adjudicator will look at the same forms and evidence already submitted and search for any errors made by the initial reviewer that may have resulted in an incorrect denial.
To request higher-level review, veterans or their VA-accredited disability attorneys must complete form VA 20-0996. This form can be downloaded and mailed, submitted in person to a VA regional office or completed online.
If veterans disagree with the decision from the higher-level review process, they can file for a Board appeal or, with additional evidence, file a supplemental claim.
#2 Appealing a denied VA claim by submitting a supplemental claim
Forms needed: VA Form 20-0995
Deadline to appeal: 1 year from the date on the decision letter
Time to decision: An average of 4-5 months, as of this writing
New evidence requirement: New evidence required
If you have new evidence to submit that you did not include in your initial application, you can file a supplemental claim.
When the VA receives a supplemental claim, a reviewer will re-evaluate the case with the new evidence to determine if they should revise the initial decision.
The new evidence submitted must fit the VA’s definition of “new and relevant,” meaning the VA did not have this evidence before its last decision and that it could “prove or disprove” part of the disability claim.
To appeal by filing a supplemental claim, veterans or their VA-accredited disability attorneys must complete form VA 20-0995. This form can be downloaded and mailed or submitted in person to a VA regional office.
If veterans disagree with the decision from the supplemental claim process, they can file for higher-level review or a Board appeal.
#3 Appealing a denied VA claim by requesting an appeal with the Board of Veterans’ Appeals (Notice of Disagreement)
Forms needed: VA Form 10182
Deadline to appeal: 1 year from the date on the decision letter
Time to decision: 1 year +, as of this writing
New evidence requirement: Dependent on the type of review
To have a Veterans Law Judge (a federal claims adjudicator) review the case, veterans can request an appeal with the Board of Veterans’ Appeals (BVA).
To request an appeal to the BVA, veterans or their VA-accredited disability attorneys must complete VA Form 10182, also known as the Notice of Disagreement (NOD). This form can be downloaded and mailed, submitted in person to a VA regional office, or completed online.
On this form, veterans can choose one of three types of reviews:
- A direct review: Requesting that the board review existing evidence without a hearing. Wait time to decision is about one year.
- Evidence submission: Submitting additional evidence (within 90 days of filing the appeal) for the board to review and consider without a hearing. Wait time to decision is more than one year.
- Hearing: Requesting a hearing with a Veterans Law Judge. Veterans can submit optional additional evidence at the hearing or within 90 days of the hearing, but it is not required. This hearing can be done virtually from the veteran’s home, via video conference at a local VA location, or in person in Washington, D.C. Wait time to decision is more than one year.
To determine which option is the best for each case, the VA recommends working with a VA-accredited legal representative.
If veterans disagree with the decision from the Board Appeal process, they can file a supplemental claim or appeal to the U.S. Court of Appeals for Veterans Claims.
Deadline for appeals
If a veteran misses the appeal deadline but has new evidence to include, they can file a supplemental claim. Because they missed the initial deadline, the VA would connect their benefits with this new, latest filing date, not the earlier date that the VA first received the initially denied claim.
How Woods and Woods can help
With several approaches and nuances in the appeals process, it can feel overwhelming to know how to move forward. That’s why the VA recommends veterans seek accredited representation to help them find the best option.
“There is no one-size-fits-all option,” said Neil Woods, a VA disability lawyer. “At Woods and Woods, we’re going to look at your claim on a case-by-case basis to determine which of the three appeals options best suits you.”
Woods and Woods has helped thousands of veterans with their VA disability applications and appeals. Call us today to discuss your VA disability appeal or your first application. The call is free and we won’t charge you a single fee until we win your case.
Talk to Us About Your Claim: (812) 426-7200
“I highly recommend this firm, they are honest and straightforward. They are fair in their billing and quite good at gathering the facts and building a case for their client.“
FREQUENTLY ASKED QUESTIONS
The VA may claim your condition or injury was not service-connected. In this case, the type or amount of evidence submitted did not meet the VA’s standard of proof—the requirement that the evidence must show it was “at least likely as not” that the disability was a result of military service.
Unfortunately, there is no one-size-fits-all option. Consult a VA disability lawyer to determine which of the three appeals options is the best fit for your case.
