Navigating the Appeals Process After a VA Disability Denial

What Are the Different Types of VA Disability Benefits Claims?

Veterans eligible for disability claims because of certain conditions sustained in service to their country may file claims with the United States Department of Veterans Affairs (VA). However, filing a claim and getting that claim approved so that you may receive the disability benefits you require is not always a simple process.

There are several different types of VA disability benefits claims. These include the following:

•         Initial claims: this is the first and original claim that a veteran files for a specific medical condition. Initial claims establish the connection between the medical condition and service. There are several different types of service connections, including direct service connections, secondary service connections, presumptive service connections, and service connections by aggravation.
•         1151 claims: these types of claims are relevant to cases of medical malpractice or medical negligence on the part of the VA regarding medical care, work therapy programs, or vocational rehabilitation programs.
•         Increased rating claims: if a service connected condition has worsened, a veteran may file for an increased rating claim. These types of claims come into play when veterans require higher evaluations for service-connected conditions.
•         Supplemental claims: if there is new evidence to support service connection for a previously denied claim, a supplemental claim is available. 
•         Claims as part and parcel to other pending claims: specific claims, such as total disability based on individual unemployability and special monthly compensation claims, can be filed independently. However, veterans and their legal representation have the option to raise these matters as part of existing claims or appeal for increased ratings

Why Are VA Disability Claims Sometimes Denied?

Before you file your disability benefits appeal, you must understand why the VA may have denied your claim.

Common reasons for a disability claim denial include the following:

•         Lack of medical evidence: The VA may deny your benefits claim if they believe there was not sufficient medical evidence to prove your medical conditions are either service-connected or severe enough to warrant compensation.
•         Failure to establish a service connection: those who failed to provide sufficient evidence linking their medical conditions to their military duty and service may see their claims denied.
•         Missed deadlines: necessary forms and documentation must be filed according to strict deadlines. If you miss a deadline, the VA may deny your claim.

There are several reasons to file an appeal. Perhaps you believe the VA did not assign the correct disability rating to your condition. You may have reason to appeal if you think your condition is more severe than the rating assigned. Additionally, you may believe that the VA did not consider all your service-related disabilities when making its ruling. Or perhaps your claim was denied, and you feel an error was made in the decision to deny your claim.

Can You Appeal the VA Determination?

Veterans can appeal the VA’s decision on their benefits claims applications through several means. These options allow veterans to request reviews, present additional evidence, address potential procedural errors, or clarify misinterpretations of their applications.

A higher-level review (HLR) may be the correct course of action if you believe your claim was denied based on an error in judgment, the interpretation of evidence, or a mistake in understanding the law. Veterans can also request informal conferences to explain their cases.  This type of appeal must be filed within one year of the decision being appealed. 

If you have additional evidence not included in your original benefits claim submission, a supplemental claim allows you to submit new evidence for reconsideration. This type of claim can be filed at any time but in order to preserve the effective date associated with the original claim, the appeal must be filed within one year.

If your case is more complicated, you can apply directly to the Board of Veterans Appeals, an independent entity within the VA that examines cases and provides a formal hearing process if necessary. This is the most time consuming option, the wait for a decision from the Board can be years long.  It is important to ensure that you have fully developed your appeal via supplemental claims and higher level reviews before appealing to the Board.  

What is the VA Disability Appeals Process?

The first step is to review your denial letter, which should explain why the VA decided to deny benefits. After a careful review, you should understand which appeal option should be most effective for your legal needs.

Every appeal option has specific requirements. Please contact our law firm to learn how to file an appeal and which appeal is right for your case.

Before submitting your appeal, gather all relevant evidence that could help support your claim. Valuable evidence may include relevant medical records, service documents, and professional statements supporting your claim. Ensure that the evidence you provide addresses specific reasons for the original denial.

Once you have gathered the appropriate evidence and decided on the correct appeal option for your case, you must file the proper form with the Veteran Affairs office. For an HLR, you would file VA form 20-0996. For a supplemental claim, you must file VA form 20-0995. For a Board of Veterans appeals, you would file VA form 10182.

If you are filing for a higher-level review, you may request an informal conference, which provides you with the opportunity to speak directly with the reviewer of your case. If you are appealing to the Board of Veterans Appeals, they may offer you a formal hearing either virtually or in person.

When Should Veterans Appeal a VA Decision?

Just because your claim was denied does not mean that that’s the end of the road. You have several options for appealing a decision. However, you must make these decisions before waiting too long.

You should consider appealing the VA’s decision-making in the following scenarios:

•         Your claim was denied entirely, and you believe you qualify for benefits
•         You disagree with the effective date of disability benefits and believe that they should start sooner
•         You received a lower disability rating than you anticipated, and you believe your condition warrants a higher rating

Contact our law firm to schedule a consultation with our legal team today.

How to Improve the Likelihood of a Successful VA Appeal?

Before filing your appeal, it’s important to remember that you needn’t go through this process alone. Our lawyers provide dedicated and compassionate legal representation to clients undergoing the VA appeals process. We would be proud to represent your interests in pursuing a satisfactory outcome to your case. Hiring professional legal representation may be the most highly recommended step to improve the likelihood of a successful appeal.

Other valuable tips and suggestions that could improve the likelihood of a successful appeal include the following:

•         Be thorough in all your documentation and paperwork
•         Consider seeking help from a veteran service organization
•         Do not miss your deadlines
•         Ensure that you submit new and relevant evidence when you submit a supplemental claim
•         If the VA makes a request of you for additional evidence or information, respond promptly
•         Maintain comprehensive records
•         Make routine follow-ups and stay engaged throughout the process
•         Obtain a nexus letter from your health care provider
•         Work with legal counsel to prepare for a VA hearing

Schedule an In-Depth Case Evaluation with Our Experienced Legal Team Today

If you are going through the appeals process, our law office can assist you at any stage. We offer our legal knowledge and aggressive representation to every client interested in our legal services.

We encourage you to work with professional legal representation to improve your chances of having your appeal approved. To learn more about how we can provide legal guidance throughout the complex appeals process, please contact our law firm to schedule your initial consultation with our legal team today.

You can reach us at 608-975-3042.