Veterans Health Benefits Decision Review Process
Like with other types of insurance plans, you can appeal to the Veterans Administration (VA) if your claim is denied. You can request a decision review for the following reasons:
You have new evidence.
File a Supplemental Claim form if you have new and relevant evidence that were not considered when the decision was made. This type of review process can take four to five months.
There’s an error in your case (and you don’t have new evidence).
You can request a Higher-Level Review if you believe there’s an error with the decision on the claim you have made. A reviewer will consider the previously submitted documentation. For this type of review, you must complete the Higher-Level Review form. You can also request a one-time, informal conference to help identify specific errors in the case. This type of review process can take four to five months.
Board Appeal
A judge who is an expert in Veterans law will review your case. This level of appeal can only be requested after an initial claim, and you have received either a Supplemental Claim or Higher-Level Review decision. You have one year from the date on your decision letter to request this type of appeal.
If you disagree with the decision, you can request another review.
Help with your VA health benefits decision review
You can allow someone to represent you — including a family member, friend, doctor, lawyer or advocate — by filling out VA Form 21-22a Appointment of Individual as Claimant’s Representative. Some veterans service organizations or state veterans offices may also help. Find qualifying services by accessing the Directory of Veterans Service Organizations. Note that not every organization has been reviewed by the government. Go to Department of Veterans Affairs, Accreditation Search to make sure they have a government accreditation. To give VA organizations permission to help you, fill out VA Form 21-22 Appointment of Veterans Service Organization Claimant’s Representative.
Additional VA decision reviews and appeals information
During the appeals process, you can ask for a local office hearing in which you meet with a VA hearing officer. This isn’t required. It just allows you to find out if you need more information for your appeal. To set up the meeting, go to the Veterans Affairs website and click on your state to get the phone number of your VA regional office. For more information on VA health benefits appeals, visit military.com.
