VA Appeals Process and Options under the Appeals Modernization Act, Study Guides, Projects, Research of Law

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VA Appeals

Appeals Process

▪ The appeals process is used to continue a claim that has been

denied benefits by the VA

▪ The same three things needed for a successful claim are also

needed for a successful appeal: military service (other than

dishonorable), a diagnosed condition, and a NEXUS to connect

them together.

▪ Use Georgia Department of Veterans Service (GDVS) for advice

and filing of appeal.

Appeals Options

Appeals Options

▪ Under the AMA there are three options for review : ▪ Option 1 : Higher Level Review Lane ▪ Claim is reviewed by a more senior claims adjudicator - Decision Review Officer ▪ Filing VA Form 20-0996 (Decision Review Request-HLR)- must be filed within 1 year. ▪ A higher level de novo review (new look) of the decision ▪ No submission of new evidence is allowed ▪ The possibility of overturning the decision based on a difference of opinion or clear and unmistakable error (CUE) ▪ Can request a one time telephone call with the reviewer to identify specific errors in your case (not guaranteed) ▪ Goal is 125 days to complete

Appeals Options Cont.’

▪ Option 3 : Board Lane- Board of Veteran Appeals (BVA ) ▪ Process starts with the completion and receipt of VA Form 10- 182 (Board Appeal Notice of Disagreement). ▪ You only have 1 year from the date of the Notice of Decision or Statement of the Case (SOC) to file the VA Form 10-182. ▪ You have 3 choices in the board lane: Direct Review, Evidence Submission and Hearing ▪ Direct Review — ▪ Evidence Submission — ▪ Hearing -

Appeals Options Cont.’

▪ Option 3 : Board Lane- Board of Veteran Appeals (BVA ) ▪ Direct Review — ▪ do not want to submit additional evidence or have a hearing. ▪ Average response time is 356 days. ▪ Evidence Submission — ▪ Submit additional evidence without a hearing, ▪ 90 days from the NOD to submit additional evidence ▪ Hearing - ▪ Submit additional evidence and have an in-person hearing before a VLJ. ▪ Scheduled hearing ▪ May submit evidence within 90 days after the hearing —will take longer than a year

Proposed Reductions

Proposed Reductions ▪ A proposed reduction is a process used to screen the current severity of a veterans condition and apply the appropriate compensation. ▪ These conditions are considered unprotected ▪ Disability rating less than 5 years). ▪ Every time a veteran applies for compensation (initial or increase) they are screened for a proposed reduction. ▪ Proposed reductions are also triggered by conditions that are deemed not permanent such as prostate cancer—those conditions are tagged with a future exam. ▪ Most proposed reductions are triggered by the ▪ veteran themselves continually applying for compensation.

Questions?

Check on Learning

▪ What are the three appeals options under the Appeals Modernization Act (AMA)? ▪ How long does a veteran have to appeal a denial on a rating decision under AMA? ▪ Can you submit additional evidence under AMA Higher Level Review? ▪ Can you appeal a board decision higher?