If you disagree with a health care decision, you have options.
by VHA's Claims and Appeals Modernization Office
As a Veteran, you deserve the best health care possible. But you may not always agree with decisions we make about your medical care or whether you are eligible for some types of care.
If you disagree with a decision we made, you can appeal it. Here’s how.
First, a word about where benefits come from within VA. The Veterans Benefits Administration (VBA) handles non-health benefits, including service-connected compensation, education, dependency and indemnity compensation, VA home loans and life insurance. The Veterans Health Administration (VHA) also has its own set of health benefits involving your health care and eligibility for certain health services.
Two kinds of health care decisions, two kinds of appeals
In VA health care, you can appeal two kinds of decisions: medical determinations and health benefits decisions.
A medical determination is a decision made by your care team about your health care, like whether to prescribe a certain medication, treatment or physical therapy. It can also mean a decision to refer you to a community provider for care.
A health benefits decision is about whether or not you are eligible for VA health benefits, such as VA health care, VA nursing home and domiciliary care, reimbursement for non-VA emergency care and certain medical devices.
How to appeal a medical determination
You can appeal a medical determination by filing a Clinical Appeal, which allows other medical professionals to review your medical needs and decide whether the determination was correct.
To file a Clinical Appeal, contact the patient advocate at your VA medical facility and ask to initiate a Clinical Appeal.
How to appeal a health benefits decision
If you disagree with a health benefits decision, you can request one of three types of review:
Appeal to the Board of Veterans’ Appeals
You can select the type of review you think is best for your case.
When and how to request a Higher-Level Review
If you believe our decision was wrong and you don’t have new evidence, a Higher-Level Review may be your best option. You can’t submit any new evidence, but instead a senior reviewer will look at your case again. This reviewer will evaluate the same evidence that was previously considered. You must file a request for 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 reviewer to discuss your case.
To request a Higher-Level Review, fill out VA Form 20-0996 and follow the submission instructions on your VHA decision notice letter.
When and how to file a Supplemental Claim
If you believe our decision was wrong and you have new and relevant evidence that VA hasn’t already considered, a Supplemental Claim may be your best choice. We can help you gather any new evidence you identify, such as medical records, to support your claim. A reviewer will decide if this new evidence changes the decision. You can generally file a Supplemental Claim at any time after the decision.
To file a Supplemental Claim, fill out 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 at the Board of Veterans’ Appeals (Board) to review your case, you may 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 Higher-Level Review or file a Supplemental Claim before appealing to the Board.
There are three types of Board review. When you fill out the form, you’ll need to request which type you want:
Direct Review: If you don’t want to submit additional evidence or have a hearing
Evidence Submission: If you want to submit additional evidence without a hearing
Hearing with a Veterans Law Judge: If you want to have a hearing with a Veterans Law Judge with the option to submit new evidence
To appeal a decision to the Board, fill out VA Form 10182 and send it to the Board. The mailing address is in the form.
How to appeal a Caregiver Support 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 any of the three benefits decision appeals options. For more information, review your CSP decision letter or visit the CSP website.
How to find help with an appeal
If you need help filing a claim or appeal, you may want to work with an accredited attorney, a claims agent or a Veterans Service Officer (VSO). We trust these professionals because they’re trained and certified in the VA claims and appeals processes. They can help you with VA-related needs.
VSOs work on behalf of Veterans and service members, as well as their dependents and survivors. Find out more about professionals who can help you.
For more information
Visit the VHA appeals website for more information.