Veterans, their families, and advocates often find navigating the intricacies of the Department of Veterans Affairs (VA) benefits system a daunting task. Today, we embark on a detailed exploration of one critical aspect – VA Higher Level Reviews (HLR). Joining us is Garen Cone, a distinguished Air Force veteran, accredited claims agent, and a passionate legal advocate for veterans. He offers invaluable guidance on understanding the HLR process and maximizing its potential to correct errors and secure favorable outcomes for veterans. Together, we aim to unravel the complexities of HLR and empower veterans to understand their options in the appeals process.
Garen Cone and AVET Appeals: A Legacy of Advocacy
Garen Cone’s journey into advocacy stems from personal experiences as an Air Force veteran injured during the Grenada conflict. With over three decades of dedication, he has become an accredited claims agent and founded AVET Appeals. This organization plays a pivotal role in assisting individuals who have faced denials in their claims and seek redress.
The Evolution with Appeals Modernization Act (AMA)
To comprehend the significance of VA Higher Level Reviews, we must first understand the context within the Appeals Modernization Act (AMA). Introduced to address the shortcomings of the Legacy process, which applied to appeals before February 2019, the AMA ushered in a new era with three distinct lanes for veterans to pursue. This streamlined process with three decision review options provides faster resolutions and clearer communication.
- Higher-Level Review: A senior claims adjudicator conducts a de novo (new) review of the decision without the submission of new evidence. This option can overturn decisions due to a clear and unmistakable error or a difference of opinion. Veterans may also request an informal conference to discuss legal or factual errors.
- Supplemental Claim: Veterans can submit new and relevant evidence to support their claim, with VA assistance in developing the evidence.
- Appeal to the Board of Veterans’ Appeals: Veterans can opt for direct review, submit additional evidence, or request a hearing with a Veterans Law Judge.
The AMA aims to give veterans more control and faster outcomes, offering flexibility and a clear framework while ensuring the earliest possible effective date for their benefits.
Understanding VA Higher-Level Reviews (HLR)
A VA Higher-Level Review (HLR) is an alternative for veterans who are unsatisfied with the outcome of their initial disability compensation claim. This review process focuses on the original evidence, with no new submissions allowed, and is conducted by a senior adjudicator who re-evaluates the claim for potential errors or oversights.
How Higher-Level Review Differs from Traditional Appeals
The Higher-Level Review differs from traditional appeals in a few key ways:
- No New Evidence: HLR is based solely on the evidence submitted during the initial claim. This makes it a faster option compared to appeals that may require gathering additional documentation.
- Faster Decision Timeline: Intending to resolve cases within 125 days, HLR provides a quicker resolution than standard appeals.
- Informal Conference Option: Veterans can request an informal meeting with the senior reviewer to discuss potential errors in the original decision.
Best Times to Request a Higher-Level Review
Veterans often choose HLR when they suspect an error was made in the initial decision. This could include incorrect disability ratings or missed evidence. However, if new information is available, a Supplemental Claim may be a better option. Additionally, HLR cannot be used after a prior HLR decision on the same claim has been made. Understanding when and how to use the VA Higher-Level Review can help veterans navigate the appeals process effectively.
Advantages of VA Higher-Level Reviews
Opting for a VA Higher-Level Review (HLR) provides several key benefits for veterans appealing a disability claim decision.
- Faster Processing Time: A VA Higher-Level Review (HLR) typically offers a quicker resolution in around 125 days, making it one of the fastest appeal options.
- Straightforward Process: The HLR process is straightforward as it focuses on the review of existing evidence, eliminating the need for veterans to submit new documentation.
- Experienced Reviewers: Senior VA adjudicators handle HLRs which increases the likelihood of identifying errors or oversights made in the initial decision.
- Error Correction without New Evidence: Veterans can use HLR to address mistakes in their original claim without needing to introduce new evidence. This is particularly useful if they believe the denial or lower rating was due to an error in the initial evaluation.
These streamlined processes, combined with quicker decisions, make HLR an appealing choice for veterans seeking swift resolution of their VA claim appeals.
VA Higher-Level Review (HLR) Process
The VA Higher-Level Review (HLR) process offers veterans the opportunity to request a fresh review of their disability claims. This review is conducted by a senior adjudicator who focuses on the original evidence, aiming to identify any errors in the initial decision. Below is a step-by-step guide on what to expect when filing for an HLR, including the filing process, decision review, and optional informal conference.
Filing for a VA Higher-Level Review
To begin the HLR process, veterans and/or their advocates must submit VA Form 20-0996 within one year of receiving the original decision letter. You can file the form online, by mail, or in person at a VA office. Using the correct forms is crucial under the AMA, as failing to do so can result in the VA returning your claim.
During the HLR submission, veterans should ensure the forms are completed correctly, clearly identify any errors in the original decision, and request reconsideration for a detailed re-evaluation. It’s important to note that no new evidence can be submitted during the HLR as the review will focus solely on the evidence presented in the original claim.
Informal Conference (Optional)
Veterans have the option to request an informal conference as part of the HLR process. This telephonic call or video conferences allow you or your representative to discuss the case directly with the senior rating veteran service representative, helping clarify points of disagreement. If requested, the VA will schedule the call early in the review process.
Keep in mind that the VA will only make two attempts to schedule this call, so timely participation is crucial. This personalized approach facilitates direct communication and a better understanding of the nuances involved.
The VA will review whether it made a duty-to-assist error in the prior decision, returning the claim for further development if necessary. Furthermore, it will notify the claimant if any new, unconsidered evidence is submitted, as it cannot be reviewed during the Higher-Level Review.
Decision Review and Timeline
Once the review begins, a senior adjudicator, who was not involved in the original decision, will re-examine your case file. The process is known as a de novo review, meaning the reviewer will analyze all the evidence independently without considering previous conclusions. While the VA aims to complete reviews within 125 days, actual timelines may vary depending on the complexity of the case.
Upon completion, you’ll receive a decision letter outlining the results. If errors are identified, your claim could be adjusted, and benefits updated accordingly. If veterans disagree with a VA decision, veterans can file a Supplemental Claim or appeal to the Board of Veterans’ Appeals.
Expert Tips for a Successful VA Higher-Level Review
The VA Higher-Level Review (HLR) is a valuable option for veterans who believe errors were made in their initial disability claim decision. It allows a more experienced higher-level reviewer to reassess the claim based on the same evidence, without introducing new documentation. To maximize your chances of success, Garren Cone offers essential tips to guide you through the process.
- Identify the Purpose of Higher-Level Reviews: The HLR is designed to correct errors in the original decision based on existing evidence. If new evidence is needed, a Supplemental Claim may be a more appropriate option.
- Examine the Initial Decision: Analyze your VA decision letter closely to identify where the VA may have misapplied the law or overlooked evidence. For instance, if your medical records suggest a higher disability rating, make sure to highlight these discrepancies.
- Craft a Detailed Written Statement: Instead of requesting an informal conference, submit a clear, well-organized written statement outlining specific errors and your disagreements with the VA’s decision.
- Explain Your Disagreements in Detail: Provide a detailed explanation of exactly which parts of the decision are incorrect and why, helping the higher-level reviewer focus on the critical errors.
- Keep Your Documentation Organized: Although no new evidence is allowed, organizing your current documents can streamline the review process and aid in clear communication during the review.
- Stay Updated and Record Everything: Keep track of the status of your review, and maintain records of all communication with the VA to avoid unnecessary delays.
Garen Cone’s Insights on VA Higher Level Reviews
Garen Cone, drawing from his extensive experience, emphasizes the significance of understanding these processes. He highlights the indispensable role of organizations like Prestige Veteran, specializing in independent medical opinion and AVET in guiding veterans through the complex landscape of benefits. These organizations offer personalized support, helping veterans understand their rights, gather essential documents, and ensure the proper filing of appeals, including the correct use of VA Form 20-0996.
Cone also emphasizes the importance of filing HLR requests with precision, as errors or omissions can lead to delays or denials. He advises veterans to review their initial decision letters carefully, looking for any misinterpretation of facts or law and ensuring that all relevant documentation is organized before submission.
Beyond HLR: Unpacking the FAQ Sheet
While we’ve delved into the intricacies of VA Higher Level Reviews, Leah Bucholz and Garen Cone’s discovered FAQ sheet serves as a treasure trove of additional insights. As veterans navigate the appeals process, this comprehensive resource provides clarity on the nuances and intricacies of the Appeals Modernization Act (AMA), addressing common questions about timelines, informal conferences, and further appeal options like Supplemental Claims and Board of Veterans’ Appeals. This resource, along with expert advice from advocates like Cone, helps veterans make informed decisions and maximize their chances for a favorable outcome.
Conclusion
In conclusion, Garen notes that VA Higher Level Reviews represent a valuable option for veterans seeking redress after facing a denial. This avenue allows for a reevaluation of cases based on identified errors in fact or law. Garen Cone’s insights underscore the importance of comprehending these processes, emphasizing the collaborative role of organizations committed to guiding veterans through the intricate web of benefits.
Knowledge is a powerful tool, and sharing information is pivotal in supporting veterans on their journey to justice. Stay engaged, stay informed, and together, let’s ensure our veterans receive the benefits they rightfully deserve.
Also read: Bruxism and PTSD in Veterans Disability
At Prestige Veteran Medical Consulting, a veteran-owned company, we specialize in Independent Medical Opinions (IMOs) known as Nexus letters.
Our purpose is to empower YOU, the veteran, to take charge of your medical evidence and provide you with valuable educational tools and research to guide you on your journey.
Understanding the unique challenges veterans face, our commitment lies in delivering exceptional service and support.
Leveraging an extensive network of licensed independent medical professionals, all well-versed in the medical professional aspects of the VA claims process, we review the necessary medical evidence to incorporate in our reports related to your VA Disability Claim.
Prestige Veteran Medical Consulting is not a law firm, accredited claims agent, or affiliated with the Veterans Administration or Veterans Services Organizations. However, we are happy to discuss your case with your accredited VA legal professional.
