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Higher Level of Review

Definition

The Higher Level of Review is a part of the VA benefits appeal process, allowing veterans to request that a more experienced adjudicator re-evaluate their claim decision. This is typically done if the veteran disagrees with the initial decision made on their claim. The objective is to have a senior reviewer assess the evidence and determine if any mistakes were made to ensure a fair outcome.

Key Takeaways

  1. A Higher Level of Review is an option within the VA benefits appeals process that allows a more experienced adjudicator to re-evaluate your claim decision.
  2. This review can be requested if you disagree with a decision made on your VA benefits claim and believe that an error was made, without having to submit new/additional evidence.
  3. Choosing a Higher Level of Review means that you cannot submit new evidence or request a hearing, making it a quicker resolution option compared to the traditional appeals process.

Importance

The Higher Level of Review (HLR) is an essential term in VA benefits as it offers veterans a chance to request reconsideration of their claims by a more experienced claims adjudicator when they disagree with the initial decision made by the Department of Veterans Affairs.

This review process can play a crucial role in ensuring that veterans receive accurate and favorable decisions on their benefits claims, as the higher-level adjudicator may identify errors, consider new evidence, or provide a better understanding of the case.

Ultimately, the HLR enhances the quality and fairness of the VA benefits system, ensuring that veterans receive the support and benefits they deserve.

Explanation

Higher Level of Review serves as a vital component in the VA benefits claims process, specifically designed to support veterans in receiving accurate and fair decisions regarding their claims. The primary purpose of this review mechanism is to provide veterans with an opportunity to have their claims re-evaluated if they believe that inaccuracies or misjudgments were made during the initial evaluation phase.

By offering this additional layer in the claims process, the Department of Veterans Affairs ensures that veterans have access to a comprehensive and unbiased evaluation of their claims, taking into account any new evidence or differing perspectives that may affect the outcome of the decision. The essence of the Higher Level of Review is empowering veterans to challenge Supplemental Claim or initial claim decisions by seeking a more experienced adjudicator, with the aim to reach a just resolution.

During this process, the reviewer will thoroughly examine the claim, considering all the evidence that was available during the initial or supplemental decision-making phase. Importantly, the Higher Level of Review does not allow for new evidence submission, focusing on accuracy and proper application of VA laws and regulations.

This review option serves as a testament to the VA’s commitment to transparency, accountability, and advancing the best interests of veterans and their families by providing them with the necessary resources and support to ensure their rights and entitlements are fully recognized and upheld.

Examples of Higher Level of Review

The VA Benefits term, “Higher Level of Review” refers to a process in which a more experienced adjudicator or expert re-evaluates a veteran’s claim for disability benefits after the initial decision has been made. This process may result in a different outcome or decision for the veteran, positively impacting the benefits they receive based on reassessment of evidence and facts. Here are three real-world examples:

Example 1: A veteran had submitted a claim for service-connected Post-Traumatic Stress Disorder (PTSD) but received a denial. The veteran believed that the decision was incorrect, as they provided sufficient evidence and medical records documenting their PTSD. They chose to request a Higher Level of Review, during which a more experienced adjudicator reconsidered the evidence and ultimately approved the claim, granting the veteran the appropriate disability compensation.

Example 2: A veteran received a disability rating of 30% for chronic lower back pain resulting from their military service. After some time, the veteran noted that their condition had significantly worsened, and they felt that the current rating did not adequately represent their level of disability. They requested a Higher Level of Review, and upon re-evaluation of their claim, the experienced adjudicator agreed, raising their disability rating to 50%.

Example 3: A veteran initially received a 10% disability rating for tinnitus associated with their military service. However, they also suffered from hearing loss that they believed was connected to the same service-related injury. The veteran requested a Higher Level of Review, providing additional evidence of hearing loss and its relation to their military service. Upon review, the more experienced adjudicator agreed with the veteran’s claim, awarding a separate disability rating for the hearing loss and increasing the veteran’s overall disability compensation.

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FAQ on Higher Level of Review

What is a Higher Level of Review?

A Higher Level of Review (HLR) is a process that Veterans can request for a second review of certain types of decisions. Veterans can ask for a Higher Level of Review after receiving an unfavorable decision from their initial claim, and an HLR will be conducted by a more experienced adjudicator.

How do I request a Higher Level of Review?

To request a Higher Level of Review, you must complete VA Form 20-0996, Decision Review Request: Higher-Level Review. You can either submit this form online through the VA website, in person at your local VA office, or by mailing it to your local VA office.

What situations are eligible for a Higher Level of Review?

Situations eligible for a Higher Level of Review include, but are not limited to: initial disability claim decisions, rating decisions, and pension decisions. If you are unsure whether your situation is eligible for HLR, you can consult with a VA representative or an accredited representative, such as a Veterans Service Organization (VSO).

Can I submit new evidence during a Higher Level of Review?

No, new evidence cannot be submitted during a Higher Level of Review. The HLR process only reviews the evidence that was originally submitted with your claim. If you would like to submit new evidence, you may need to consider the Supplemental Claim option instead.

How long does a Higher Level of Review take?

The processing time for a Higher Level of Review can vary depending on factors such as the complexity of the review and the current volume of requests. Generally, VA aims to complete Higher Level Reviews within 125 days, but this can be longer or shorter depending on the specific case.

What happens if the Higher Level of Review results in an unfavorable decision?

If the Higher Level of Review results in an unfavorable decision, you have options to appeal further. You can either submit a Supplemental Claim with new and relevant evidence, request a Board Appeal via a Notice of Disagreement (VA Form 10182), or explore other available options with the assistance of a VA representative or an accredited representative.

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Related VA Benefit Terms

  • Appeals Modernization Act
  • Supplemental Claim
  • Board of Veterans’ Appeals
  • Decision Review Officer
  • Notice of Disagreement

Sources for More Information