Finding the Right Path After a VA Higher Level Review Process Denial
Mike Thompson stared at the VA decision letter on his kitchen table, the denial of his knee injury claim hitting him like a punch to the gut. The VA higher level review process would be his next step, though he wasn’t sure exactly how it worked. After fifteen years as an Army infantryman with three combat tours, his medical records clearly documented the injury from a training exercise.
“This makes no sense,” he muttered, running his hand through his salt-and-pepper hair. Consequently, his phone buzzed with a text from Darius, a buddy from his unit who’d successfully navigated the VA higher level review process.
“Got your message. Don’t appeal to the Board yet. Too many options to discuss over text. Coffee tomorrow?”
Discovering Options for VA Higher Level Review Process
The next morning at Veterans Brew, a small coffee shop near the VA hospital, Mike slid the denial letter across the table. Darius studied it carefully, occasionally nodding.
“See this part here?” Darius pointed to a paragraph about insufficient evidence of service connection. “They’re not saying your knee isn’t injured. Rather, they’re saying they don’t see how it connects to your service.”
“But it’s right there in my records,” Mike protested. “The medic documented everything after that training exercise in 2014.”
Understanding VA Higher Level Review Process Advantages
“I see your problem,” Darius said. “You’ve got three options: file a supplemental claim with new evidence, appeal to the Board which could take years, or request a higher-level review.”
Mike frowned. “VA higher level review process? Never heard of it.”
“It’s part of the Appeals Modernization Act from 2019,” Darius explained. “The VA higher level review process involves a senior reviewer—someone with more experience who wasn’t involved in your case—taking a fresh look at everything already in your file. Additionally, they might catch mistakes the first rater missed, even though no new evidence is considered.”
Why VA Higher Level Review Process Is Faster Than Appeals
“How long does this VA higher level review process typically take?” Mike asked, hope flickering for the first time since receiving the denial.
“The VA aims for completion within 125 days. Sometimes it stretches to 4-6 months, but that’s still way faster than the years you’d wait for a Board appeal.”
Mike considered his options. “So in this VA higher level review process, I’m basically asking for a second opinion from someone more experienced?”
“Exactly,” Darius nodded. “Furthermore, during the VA higher level review process, you can request an informal conference—a phone call with the reviewer where you point out specific errors in the decision.”
Making a Strategic Decision About Review Options
“Do I need new evidence? Because I found some old photos from deployment that show—”
Darius held up his hand. “That’s the key distinction. With higher-level review, they only look at what was already in your file when they made the first decision. Alternatively, if you have new evidence, you’d want a supplemental claim instead.”
Mike studied his denial letter again. “So this is only about finding errors in how they interpreted what I already submitted?”
“Precisely,” Darius said. “And looking at your denial, I can already see they missed the connection. Page two mentions your service treatment records but completely ignores the incident report from your training accident.”
Developing a Strategic Approach
For the first time in weeks, Mike felt a strategy forming. “So I request this higher-level review, point out they overlooked the incident report, and basically ask a more experienced person to connect the dots they should have connected the first time?”
“That’s it,” Darius confirmed. “And you need to be specific about the error. Not just ‘I disagree’ but ‘They failed to consider the documentation on page 17 of my service treatment records that clearly establishes the injury occurred during the training exercise.'”
Starting the Review Process
Three days later, Mike submitted VA Form 20-0996, requesting a higher-level review with an informal conference. Subsequently, he spent the weekend organizing his thoughts, identifying exactly which evidence the first rater had overlooked or misinterpreted.
The Informal Conference Experience
When the informal conference call came six weeks later, Mike was ready. The reviewer, a woman named Patricia with a calm, experienced voice, listened as Mike methodically pointed out the specific oversight: “The denial states there’s insufficient evidence connecting my knee injury to service, but my service treatment records clearly document the injury during the training exercise on March 12, 2014, on page 17 of my file.”
Patricia took notes but made no promises. “I’ll do a complete review of everything in your file,” was all she said.
The Review Outcome
Exactly 118 days after filing his higher-level review request—a new decision letter arrived. Approved. The senior reviewer had identified the error, noting the original rater had failed to properly consider the documented in-service injury.
“It wasn’t about new evidence,” Mike told Darius when they met to celebrate. “Instead, it was about getting the right eyes on the evidence that was already there. About understanding how the system works and selecting the right path.”
Darius nodded. “That’s exactly it. This process is designed to be faster than traditional appeals. Therefore, understanding how to navigate it effectively is everything.”
Strategic Insights from Mike’s Experience
The strategic veteran doesn’t just disagree with decisions; they identify the specific review option that addresses their particular situation. Sometimes the fastest path isn’t adding more evidence—it’s having the right person look at the evidence you’ve already provided.
What overlooked evidence in your claim might benefit from a senior reviewer’s fresh perspective?
For a comprehensive guide to the VA Higher Level Review process, including timelines, eligibility requirements, and strategic considerations, read our full VA Higher Level Review Guide.