Everything You Need to Know About the VA’s New Appeals Process

Resolving a medical dispute isn’t easy, especially if you’re covered under a veterans healthcare plan. Unfortunately, not everyone will be able to take advantage of the benefits they deserve. More often than not, plenty of veterans are denied services because of a disagreement between the VA committee and their medical providers. An issue like this previously took years to fix, but the VA’s latest appeal system can help resolve the matter in as little as a few months.   

To fully grasp how this new appeal system works, you must understand the three-tier decision process: 

Higher-Level Reviews

If you’re looking for a fast yet thorough quality check, this is the best option. Higher-level reviews allow veterans to obtain status reviews from VA regional offices. Reviews must be filed up to a year from the initial claim. When filing for higher-level reviews, you’ll be unable to submit additional evidence or hearing requests. This review process is de novo, meaning a review without giving weight to the prior decision. If decisions are considered favorable, the original medical claim is preserved. If deemed unfavorable, though, you will be able to file supplemental claims or file a [NOD] to appeal to the Board of Veterans Appeals (BVA).  

Supplemental Claims

The new Modernization Act allows veterans to submit additional evidence under this claim category. It gives you a full year to support your case with relevant and fresh evidence. The Committee on Veteran Affairs will order an adjuster to make a decision based on your updated claim, and the process can take up to 125 days. From there, the VA will adjust your medical coverage and pay for the appropriate benefits based on the relevant evidence. If you are still not satisfied with their offer, you will have the opportunity to submit additional evidence or move on to a higher-level or board review lane.

Board Review Claims 

In this stage, your case moves from the regional office straight to the BVA. Under the board review claim, you can choose one of three services lanes:

1. Fully developed appeals: Claims ready for decisions by the BVA without the need for additional evidence.
2. Hearing requests: This is your opportunity to submit new, relevant evidence for the board to review in a legislative setting.
3. Evidence but no hearing: If you want the board to take a closer look at a set of evidence, this is your chance to provide new documentation to support your claim. 

You’ll have 120 days to file your initial appeal in this avenue. If you still find the decision unfavorable, you’ll be able to make adjustments to your claim and can file a supplemental claim within a year after the original appeal has been processed.