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As a veteran, you deserve the best health care possible. But you may not always agree with our decisions about your medical care or your eligibility for certain types of care.
If you disagree with our decision, you can appeal. Here’s how.
First, a word about where benefits come from in the VA. The Veterans Benefits Administration (VBA) handles non-health benefits, including service-connected compensation, education, welfare and compensation, VA home loans, and life insurance. The Veterans Health Administration (VHA) has its own set of health benefits that cover your health care and eligibility for certain health services.
To learn more about the benefits of VBA, please visit website.
Two types of health care decisions, two types of appeals
In VA health care, you can appeal two types of decisions: medical decisions and health benefits.
A medical decision is a decision made by your care team about your health care, such as prescribing a particular drug, treatment, or physical therapy. It may also mean referring you to a community service provider for care.
Health Benefits Decisions determine whether or not you qualify for VA health benefits, such as VA health care, VA nursing home and residential care, non-VA emergency care, and certain medical devices.
How to appeal a medical decision
You can appeal a medical decision by filing a clinical appeal, which allows other medical professionals to review your medical needs and decide whether the decision was correct.
To file a clinical appeal, contact the patient advocate at your VA medical facility and ask to initiate a clinical appeal.
Find your local patient advocate here.
How to appeal a health benefits decision
If you disagree with a health benefits decision, you can request one of three types of review:
- High level assessment
- Additional claim
- Appeal to the Board of Veterans Appeals
You can choose the type of evaluation that you think is best for your case.
When and how to request a high-level review
If you believe our decision is wrong and you don’t have new evidence, a higher-level review may be your best option. You cannot submit any new evidence, but instead a senior reviewer will look at your case again. This reviewer reviews the same evidence as previously considered. You must submit a request for a higher-level review within one year of the date of your decision.
You can also request an optional, one-time informal conference with a senior evaluator to discuss your case.
To request an advanced review, complete VA Form 20-0996 and follow the submission instructions on your VHA Decision Notice letter.
When and how to file an additional claim
If you believe our decision was wrong and you have new and important evidence that VA did not consider, a supplemental claim may be your best option. We can help you gather any new evidence you identify, such as medical records, to support your claim. The evaluator will decide if this new evidence changes the decision. You can make a further claim at any time after the decision.
To file an additional claim, complete VA Form 20-0995 and follow the submission instructions on your VHA Decision Notice letter.
When and how to appeal to the board
If you want a veterans law judge to review your case at the Board of Veterans Appeals (Board), you can appeal the decision to the Board. You must file a Board appeal within one year of the date of your decision, and you do not need to request a higher-level review or file an additional claim before filing an appeal with the Board.
There are three types of board reviews. When you fill out the form you need to ask which type you want:
- Direct review: If you do not want to present additional evidence or do not want a hearing
- Presenting Evidence: If you wish to present additional evidence without a hearing
- Hearing with a Veterans Law Judge: If you want to have a hearing with a Veterans Law Judge, you have the option of presenting new evidence.
To appeal a decision to the Board, complete VA Form 10182 and send it to the Board. The mailing address is on the form.
How to appeal a Caregiver Assistance Program decision
If you disagree with a decision about care or services under the VA Caregiver Support Program (CSP), you have four options. You can file a clinical appeal, or you can choose one of three benefits decision appeal options. For more information, review your CSP decision letter or visit CSP website.
Appeal how to get help
If you need help filing a claim or appeal, you may want to work with a licensed attorney, claims agent, or Veterans Services Officer (VSO). We trust these professionals because they are trained and certified in VA claims and appeals processes. They can help you with your VA-related needs.
VSOs work on behalf of veterans and service members, as well as their dependents and survivors. Learn more about professionals who can help you.
For more information
Visit the VHA Appeals website For more information.
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