Explaining a Higher Level Review Appeal. Once upon a time, there was an informal presumption that VA disability applicants were probably entitled to benefits. Claims Examiners looked for ways to approve requests and even offered assistance in many cases. Those days are long gone. Today, Claims Examiners typically assume that the Veteran is not severely disabled and/or the disability is not service-connected.
Therefore, many Veterans are forced to file Form 21-0996, Request for Higher Level Review
(HLR) and appeal adverse decisions. An initial denial does not mean your claim is weak or
meritless. It simply means that you are part of the crowd. Claims Examiners almost always deny
benefits applications, at least in part, hoping that Veterans will abandon their claims or settle
them for pennies on the dollar.
A good VA disability attorney does far more than help disabled Veterans fill out forms. An
attorney strongly advocates for these individuals, both in court and during settlement
negotiation sessions. Additionally, only an attorney gives Veterans solid legal advice throughout
the process, so they can make the best possible decisions.
About Form 21-0996
Veterans must submit this form when they request a higher-level review of a benefits denial.
Generally, Veterans file this form when they have a legitimate disagreement with the denial.
Examples if disagreements are that the Claims Examiner did not properly consider all evidence, new evidence is available, or the Compensation & Pension (C&P) examination doctor did not do a very good job in evaluating the claimed disability and/or offering a nexus opinion.
Apropos of nothing, thanks to the Appeals Modernization Act, it is easier to pursue appeals
based on new evidence because the burden of proof is lower. Frequently, individual Veterans
erroneously assume that the aforementioned presumption of benefits is still in place, so they do
not come fully prepared, and the available evidence is unused or underutilized.
Much of the form is relatively straightforward because it mostly requests identifying information
from the claimant. But forms that seem straightforward to lawyers are often confusing to
disabled Veterans. So, we are always here to help.
Higher Level Review Choices
In terms of an appeals forum, Veterans who file Form 21-0996 basically have two options. Either the same office which issued the denial or a different office, can review the matter. Both options have some pros and cons.
The presumption is that the HLR will be done at a different Regional Office than the one that issued the initial decision. The benefit of having a different Regional Office review the appeal rating guarantees that the Veteran will have a fresh set of eyes on the record and the HLR reviewer will not be resistant to reversing a colleague’s prior work. Because of the virtual/digital aspect of VA claims, there is little downside to having a different office review the decision.
However, the Veteran can opt to stay at the same Regional Office for the HLR. This might be
preferential if the Veteran has had positive experiences with the higher-level review officers in
the past, but this is a fact-specific situation.
Regardless of where the HLR takes place, Veterans who file Form 21-0996 may also request an
informal phone conference with the reviewing officer. Frequently, if there are holes in the
Veteran’s appeal, this conference gives claimants a chance to address them.
Issues for Higher-Level Review Appeals
Although the HLR is a more expedient way to get an initial denial reviewed than going to the Board or under the prior appeal process, there are some significant changes to keep in mind.
The most significant is that Veterans cannot submit new evidence to the review officer for an HLR. The record is closed. Also, although there is an opportunity for a hearing, it is limited to only addressing the legal arguments in support of the claim; something that most lay Veterans are not suited to handle.
Count on Dedicated Attorneys
If a Claims Examiner denies your claim, do not give up. For a free consultation with an
experienced Veterans disability lawyer, contact the Cameron Firm, P.C. at 800-861-7262 or fill out the contact box below. We are here to represent Veterans nationwide.
This article is for educational and marketing purposes only. It does not create an attorney-client relationship.
