VA Appeals: Service Connection Denial, Rating Disagreement, AMA Lanes, and Appeal Building, Lecture notes of Law

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Appeals 101

Presenter: Heather Bullerman

Outline

What is an appeal AMA appeal lanes Forms Hearings

Denial of service connection

• In order to grant service connection, all of the following must be met:
  • There needs to be an injury, event, or exposure while in service
  • The veteran must have a current diagnosis of a disability
  • There must be a nexus between the diagnosis and event (continuity of care, medical opinion)

Disagreement of percentage rated

• Review the CFR with the veteran to determine if their symptoms closer relate to the next higher percentage allowed.

Appeals Modernization

Act (AMA) lanes

AMA appeals can be submitted into three

separate lanes

• Supplemental using VA Form 20-
• Higher Level Review using VA Form 20-
• Notice of Disagreement using VA Form 10-

Supplemental

Claims

Supplemental claims

• Requires new and relevant evidence
• Worked and tracked by VSOs
• Filed anytime veteran has filed for that claim before
• No time limit
• This option is for veterans who haven’t submitted the evidence they need to
• This includes using additional evidence to raise a new theory or entitlement
• Apart from the initial claim, this is the only lane where the duty to assist can be triggered
• This is the option to select if you need help getting records or need a VA examination
• When a supplemental claim is filed, the duty applies to the entire record , not just the material submitted with the supplemental claim

Supplemental claims: New and Relevant

Evidence

• A supplemental claim needs to include “new and relevant ” evidence, which may result from duty to assist efforts.
• “Relevant evidence is information that tends to prove or disprove a matter at issue in a claim. Relevant evidence includes evidence that raises a theory of entitlement that was not previously addressed.” - 38 C.F.R. § 3.2501(a)
• You may also request a pre-decisional hearing at this point in the process.

Supplemental claim things to consider

1. Why was the claim denied?
2. What evidence are you submitting about the reason for denial?
3. What do you want the regional office to do?

20-0996 Higher Level

Review (HLR)

20-0996 HLR

• Cannot include any new evidence
• Should include a statement of where VA made their error
• Must be from a decision made within the last year
• Worked by VSO or Krystal Taylor & tracked by Krystal
• Higher Level Review is for the veteran who submitted the evidence needed for grant, and the veteran needs VA to apply the law correctly
• Higher Level Review is also for a veteran who had a claim denied without VA fulfilling its duty to assist

HLR: Informal Conferences

• There are no hearings during a HLR because this would be “new evidence”
• The veteran/service officer may elect to have an “informal conference” with the HLR officer
• HLR arguments must be identified in writing or during the informal conference - This will be written by the DRO that calls the veteran and put into VBMS on a “Report of General Contact” form
• There is no prior notice as to when the call may occur

HLR:

1. Point out the error in the decision:
   • Error in duty to assist
   • Evidence incorrectly weighed or ignored
2. State the rule:
   • Duty to assist rules
   • Rules supporting grant
3. Apply the rule to the evidence already submitted
4. What do you want VA to do?
   • Send the case back to correct the error
   • Grant the claim

Arguments