Learn About The Process Of Health Care Appeals


The VA health benefits appeal process is a very complex process that includes multiple steps. The veterans health benefits appeal process uses something known as an open record system. This system allows veterans to submit medical evidence at any point during the appeal process. The VA health benefits appeal process can be a lengthy and involved experience for some veterans. Get more information about how to appeal a decision regarding veterans health benefits by reading the following topics:

  • Beginning a VA health care claim appeal
  • Using representation for a VA health care claim appeal
  • Submitting evidence for a VA health care claim appeal

Beginning a VA Health Care Claim Appeal

The veterans health benefits eligibility appeal process begins with the veteran submitting a notice of disagreement after receiving an initial assessment from the VA regarding the veterans health care application. Veterans health benefits appeal notices can be sent to the address listed on the initial ruling. When submitting the notice of disagreement, veterans will also submit any relevant evidence that the VA does not already have. If a veteran has had multiple claims denied, he or she needs to submit separate notices of disagreement for each one of the ruling.

The VA health benefits appeal process has to be started within one year of receiving the initial decision from the VA. It may still be possible to start the veterans health benefits eligibility appeal process after a year has passed, but this is much harder to arrange and not guaranteed. It is important to note that the yearlong deadline begins when the veteran receives the letter with the initial assessment, and not from the date when the initial claim was first filed.

After the VA health benefits appeal process is initiated, the veteran will be sent a number of documents relating to the case. Together, these documents are referred to as the statement of the case. The documents will contain the relevant laws, facts, regulations and reasons for the VA making the original decision that is being repealed. Along with the statement of the case, the VA sends an Appeal to the Board of Veterans Appeals form, which must be completed to move ahead with the VA health benefits appeal.

Using Representation for a VA Health Care Claim Appeal

When making a veterans health benefits appeal, veterans may seek out legal representation to assist with the appeal process. Veterans can get assistance from the Veterans Service Organization, or they can choose to hire their own lawyer. Working outside of the Veterans Service Organization does mean that the veteran will have to pay for any legal expenses out of pocket. The VA health benefits appeal process also allows veterans to hire an agent to help. An agent is someone who has legal experience with veteran’s law, but does not have a license to practice law in the United States. Typically, agents are fellow veterans who have gone through the veterans health benefits eligibility appeal process in the past.

Submitting Evidence for a VA Health Care Claim Appeal

One of the complications with a veterans health benefits eligibility appeal process is the fact that new evidence is usually being submitted. After initially being denied, many veterans will revisit the doctor or go to another medical specialist to get another opinion. This can help the VA health benefits appeal process, since the more specialists the veteran speaks with, the more evidence he or she can gather to support the case.

At any point during the VA health benefits appeal process, the veteran may submit evidence. However, this evidence must not have been previously used in the initial case. The evidence also has to offer something that strictly relates to the appeal process. Any new evidence can either be submitted in writing or the veteran can request a personal hearing at the nearest VA office.

When submitting evidence in writing for the VA health benefits appeal process, the veteran must send a copy of all documents with written statements that explain why the evidence should change the initial decision. An in-person meeting is a little more involved, since veterans can bring in witnesses to speak on their behalf. With an in-person veterans health benefits appeal, the veteran has to schedule the meeting in advance. This gives the VA time to organize a meeting and locate someone to record the hearing.

Through the veterans health benefits eligibility appeal process, the VA will go through the evidence. Once the VA arrives at a decision, it will notify the veteran. If the veteran still disagrees with the ruling, he or she has the option of pushing forward with another claim.

What are veterans benefits?

The U.S. Department of Veterans Affairs (VA) offers many helpful services to eligible veterans, service members and their families. These services include disability compensation, health care, educational funding, employment training and more. Many of these services are provided through the private sector with the support of the VA. Discover more about the benefits available to veterans, service members and their families today.

Who qualifies for veterans benefits?

Typically, the benefits available to service members, veterans and families depend on several factors. These eligibility criteria include the amount of time served, the veteran’s discharge status and more. Eligibility for veteran disability services generally depend on the nature of the disability, whether the injury was sustained during active duty and other criteria. The VA offers many services and programs, and each involves its own set of unique requirements. Veterans and service members are encouraged to learn more about which services they are eligible to receive.