VA Form 20-0996

Decision Review Request: Higher-Level Review

AppealsOfficial VA form on VA.gov

Who fills it

veteran

Journey phase

Appeals

Estimated time

20-45 minutes.

When to file

Within 1 year of decision date for effective-date protection.

You believe the original decision misread the evidence, applied the wrong regulation, or contained a clear and unmistakable error - and you do NOT have new evidence to submit (if you do, use Supplemental Claim 20-0995).

Gather before you start

—The decision letter being reviewed (date, claim number, issue(s))

—Specific identification of where you believe the original decision erred

—Whether you want an INFORMAL CONFERENCE with the higher-level reviewer (you can request a 30-min phone call to discuss the case before the reviewer decides)

Attach with the form

—Copy of the decision letter being challenged

—NO new evidence - HLR explicitly prohibits new evidence

Section I - Veteran/Claimant Identification

1 field

Blocks 1-7Name, SSN, VA File Number, address, phone, emailPII

Match exactly to your VA records as they appear on every prior letter or DD-214 - any mismatch causes intake delays.

Example

(use legal name from DD-214)

Common mistakes

Mismatched name/SSN - HLR rejected at intake.

Section II - Decision Being Reviewed

1 field · 2 citations

Block 8Date of decision being reviewed

Date on the decision letter. Starts the 1-year clock for effective-date protection on appeal.

Example

MM/DD/YYYY

Common mistakes

Using the date you received the letter instead of the date on the letter.

Authority

38 CFR 3.400 - Effective date rules including ITF protection of effective date.

38 USC 5110 - General effective-date rules and ITF protection.

Section III - Issues for Review

1 field · 2 citations

Block 9Specific issues you want re-reviewedRepeatable

List each issue with the condition name + the specific error you believe occurred. Be specific: "Denied service connection for tinnitus on the basis that there is no in-service event documented - but in-service event IS documented in STR p. 47 (12/15/2008 sick call for ringing in ears after firing range exposure) which the original rater missed."

Example

e.g.,
1. Tinnitus - DENIED. Error: rater overlooked STR p. 47 documenting 12/15/2008 in-service ringing in ears.
2. Lumbar DDD - rated 10%, should be 20% under DC 5237 because flexion limited to 60 degrees per 09/2024 C&P (rater applied wrong DC).

Common mistakes

Vague issue descriptions - identify specific error of fact or law.
Adding new evidence - HLR will reject. Use Supplemental Claim instead.
Forgetting to identify the specific error - HLR is about catching errors; without identifying one, the reviewer has nothing to act on.

Authority

38 CFR 3.2601 - The AMA Higher-Level Review lane: a senior reviewer conducts a de novo review of the same evidence in the record at the time of the prior decision to identify an error of fact or law. No new evidence is considered (use a Supplemental Claim, 3.2501, for new evidence).

M21-1 VIII.iv.1 - Supplemental, HLR, and Board appeal lane mechanics.

Section IV - Informal Conference Request

1 field

Block 10Do you want an informal conference?

YES = a 30-minute phone call with the senior reviewer before they decide. You (or your representative) can discuss the case, point to specific evidence, and clarify your argument. Highly recommended for complex cases. NO = decision based on file alone.

Example

YES (recommended) or NO

Common mistakes

Skipping the informal conference - it's the single best chance to verbally walk the senior reviewer through your argument. Almost always recommended.
Requesting the conference but missing the scheduled call - reviewer proceeds without your input.

Section V - Representative

1 field

Block 11Representative information

List your VSO, attorney, or agent. If you don't have one, consider 21-22 (VSO, free) before HLR - reps are extremely helpful in informal conferences.

Example

e.g., Disabled American Veterans (DAV)

Common mistakes

No representative on HLR - VSOs handle informal conferences in their sleep.

Related ClaimRecon tools

VA Form 21-22 - Free VSO representation - especially valuable for HLR informal conferences.

Section VI - Signature

1 field

Blocks 12-13Veteran signature and datePII

Sign and date. By signing you certify the statements are true to the best of your knowledge under penalty of perjury.

Example

(signature/date when filing)

Common mistakes

Forgetting to sign - VA returns.

Statutory & regulatory authority

38 CFR 3.400 - Effective date rules including ITF protection of effective date.

38 USC 5104B - HLR statutory authority.

38 USC 5110 - General effective-date rules and ITF protection.

M21-1 VIII.iv.1 - Supplemental, HLR, and Board appeal lane mechanics.

VA Form 20-0996

Decision Review Request: Higher-Level Review

AppealsOfficial VA form on VA.gov

Who fills it

veteran

Journey phase

Appeals

Estimated time

20-45 minutes.

When to file

Within 1 year of decision date for effective-date protection.

Gather before you start

—The decision letter being reviewed (date, claim number, issue(s))

—Specific identification of where you believe the original decision erred

—Whether you want an INFORMAL CONFERENCE with the higher-level reviewer (you can request a 30-min phone call to discuss the case before the reviewer decides)

Attach with the form

—Copy of the decision letter being challenged

—NO new evidence - HLR explicitly prohibits new evidence

Section I - Veteran/Claimant Identification

1 field

Blocks 1-7Name, SSN, VA File Number, address, phone, emailPII

Match exactly to your VA records as they appear on every prior letter or DD-214 - any mismatch causes intake delays.

Example

(use legal name from DD-214)

Common mistakes

Mismatched name/SSN - HLR rejected at intake.

Section II - Decision Being Reviewed

1 field · 2 citations

Block 8Date of decision being reviewed

Date on the decision letter. Starts the 1-year clock for effective-date protection on appeal.

Example

MM/DD/YYYY

Common mistakes

Using the date you received the letter instead of the date on the letter.

Authority

38 CFR 3.400 - Effective date rules including ITF protection of effective date.

38 USC 5110 - General effective-date rules and ITF protection.

Section III - Issues for Review

1 field · 2 citations

Block 9Specific issues you want re-reviewedRepeatable

Example

e.g.,
1. Tinnitus - DENIED. Error: rater overlooked STR p. 47 documenting 12/15/2008 in-service ringing in ears.
2. Lumbar DDD - rated 10%, should be 20% under DC 5237 because flexion limited to 60 degrees per 09/2024 C&P (rater applied wrong DC).

Common mistakes

Vague issue descriptions - identify specific error of fact or law.
Adding new evidence - HLR will reject. Use Supplemental Claim instead.
Forgetting to identify the specific error - HLR is about catching errors; without identifying one, the reviewer has nothing to act on.

Authority

M21-1 VIII.iv.1 - Supplemental, HLR, and Board appeal lane mechanics.

Section IV - Informal Conference Request

1 field

Block 10Do you want an informal conference?

Example

YES (recommended) or NO

Common mistakes

Skipping the informal conference - it's the single best chance to verbally walk the senior reviewer through your argument. Almost always recommended.
Requesting the conference but missing the scheduled call - reviewer proceeds without your input.

Section V - Representative

1 field

Block 11Representative information

List your VSO, attorney, or agent. If you don't have one, consider 21-22 (VSO, free) before HLR - reps are extremely helpful in informal conferences.

Example

e.g., Disabled American Veterans (DAV)

Common mistakes

No representative on HLR - VSOs handle informal conferences in their sleep.

Related ClaimRecon tools

VA Form 21-22 - Free VSO representation - especially valuable for HLR informal conferences.

Section VI - Signature

1 field

Blocks 12-13Veteran signature and datePII

Sign and date. By signing you certify the statements are true to the best of your knowledge under penalty of perjury.

Example

(signature/date when filing)

Common mistakes

Forgetting to sign - VA returns.

Statutory & regulatory authority

38 CFR 3.400 - Effective date rules including ITF protection of effective date.

38 USC 5104B - HLR statutory authority.

38 USC 5110 - General effective-date rules and ITF protection.

M21-1 VIII.iv.1 - Supplemental, HLR, and Board appeal lane mechanics.

VA Form 20-0996

Decision Review Request: Higher-Level Review

AppealsOfficial VA form on VA.gov

Who fills it

veteran

Journey phase

Appeals

Estimated time

20-45 minutes.

When to file

Within 1 year of decision date for effective-date protection.

Gather before you start

—The decision letter being reviewed (date, claim number, issue(s))

—Specific identification of where you believe the original decision erred

—Whether you want an INFORMAL CONFERENCE with the higher-level reviewer (you can request a 30-min phone call to discuss the case before the reviewer decides)

Attach with the form

—Copy of the decision letter being challenged

—NO new evidence - HLR explicitly prohibits new evidence

Section I - Veteran/Claimant Identification

1 field

Blocks 1-7Name, SSN, VA File Number, address, phone, emailPII

Match exactly to your VA records as they appear on every prior letter or DD-214 - any mismatch causes intake delays.

Example

(use legal name from DD-214)

Common mistakes

Mismatched name/SSN - HLR rejected at intake.

Section II - Decision Being Reviewed

1 field · 2 citations

Block 8Date of decision being reviewed

Date on the decision letter. Starts the 1-year clock for effective-date protection on appeal.

Example

MM/DD/YYYY

Common mistakes

Using the date you received the letter instead of the date on the letter.

Authority

38 CFR 3.400 - Effective date rules including ITF protection of effective date.

38 USC 5110 - General effective-date rules and ITF protection.

Section III - Issues for Review

1 field · 2 citations

Block 9Specific issues you want re-reviewedRepeatable

Example

e.g.,
1. Tinnitus - DENIED. Error: rater overlooked STR p. 47 documenting 12/15/2008 in-service ringing in ears.
2. Lumbar DDD - rated 10%, should be 20% under DC 5237 because flexion limited to 60 degrees per 09/2024 C&P (rater applied wrong DC).

Common mistakes

Vague issue descriptions - identify specific error of fact or law.
Adding new evidence - HLR will reject. Use Supplemental Claim instead.
Forgetting to identify the specific error - HLR is about catching errors; without identifying one, the reviewer has nothing to act on.

Authority

M21-1 VIII.iv.1 - Supplemental, HLR, and Board appeal lane mechanics.

Section IV - Informal Conference Request

1 field

Block 10Do you want an informal conference?

Example

YES (recommended) or NO

Common mistakes

Skipping the informal conference - it's the single best chance to verbally walk the senior reviewer through your argument. Almost always recommended.
Requesting the conference but missing the scheduled call - reviewer proceeds without your input.

Section V - Representative

1 field

Block 11Representative information

List your VSO, attorney, or agent. If you don't have one, consider 21-22 (VSO, free) before HLR - reps are extremely helpful in informal conferences.

Example

e.g., Disabled American Veterans (DAV)

Common mistakes

No representative on HLR - VSOs handle informal conferences in their sleep.

Related ClaimRecon tools

VA Form 21-22 - Free VSO representation - especially valuable for HLR informal conferences.

Section VI - Signature

1 field

Blocks 12-13Veteran signature and datePII

Sign and date. By signing you certify the statements are true to the best of your knowledge under penalty of perjury.

Example

(signature/date when filing)

Common mistakes

Forgetting to sign - VA returns.

Statutory & regulatory authority

38 CFR 3.400 - Effective date rules including ITF protection of effective date.

38 USC 5104B - HLR statutory authority.

38 USC 5110 - General effective-date rules and ITF protection.

M21-1 VIII.iv.1 - Supplemental, HLR, and Board appeal lane mechanics.

VA Form 20-0996

Decision Review Request: Higher-Level Review

AppealsOfficial VA form on VA.gov

Who fills it

veteran

Journey phase

Appeals

Estimated time

20-45 minutes.

When to file

Within 1 year of decision date for effective-date protection.

Gather before you start

—The decision letter being reviewed (date, claim number, issue(s))

—Specific identification of where you believe the original decision erred

—Whether you want an INFORMAL CONFERENCE with the higher-level reviewer (you can request a 30-min phone call to discuss the case before the reviewer decides)

Attach with the form

—Copy of the decision letter being challenged

—NO new evidence - HLR explicitly prohibits new evidence

Section I - Veteran/Claimant Identification

1 field

Blocks 1-7Name, SSN, VA File Number, address, phone, emailPII

Match exactly to your VA records as they appear on every prior letter or DD-214 - any mismatch causes intake delays.

Example

(use legal name from DD-214)

Common mistakes

Mismatched name/SSN - HLR rejected at intake.

Section II - Decision Being Reviewed

1 field · 2 citations

Block 8Date of decision being reviewed

Date on the decision letter. Starts the 1-year clock for effective-date protection on appeal.

Example

MM/DD/YYYY

Common mistakes

Using the date you received the letter instead of the date on the letter.

Authority

38 CFR 3.400 - Effective date rules including ITF protection of effective date.

38 USC 5110 - General effective-date rules and ITF protection.

Section III - Issues for Review

1 field · 2 citations

Block 9Specific issues you want re-reviewedRepeatable

Example

e.g.,
1. Tinnitus - DENIED. Error: rater overlooked STR p. 47 documenting 12/15/2008 in-service ringing in ears.
2. Lumbar DDD - rated 10%, should be 20% under DC 5237 because flexion limited to 60 degrees per 09/2024 C&P (rater applied wrong DC).

Common mistakes

Vague issue descriptions - identify specific error of fact or law.
Adding new evidence - HLR will reject. Use Supplemental Claim instead.
Forgetting to identify the specific error - HLR is about catching errors; without identifying one, the reviewer has nothing to act on.

Authority

M21-1 VIII.iv.1 - Supplemental, HLR, and Board appeal lane mechanics.

Section IV - Informal Conference Request

1 field

Block 10Do you want an informal conference?

Example

YES (recommended) or NO

Common mistakes

Skipping the informal conference - it's the single best chance to verbally walk the senior reviewer through your argument. Almost always recommended.
Requesting the conference but missing the scheduled call - reviewer proceeds without your input.

Section V - Representative

1 field

Block 11Representative information

List your VSO, attorney, or agent. If you don't have one, consider 21-22 (VSO, free) before HLR - reps are extremely helpful in informal conferences.

Example

e.g., Disabled American Veterans (DAV)

Common mistakes

No representative on HLR - VSOs handle informal conferences in their sleep.

Related ClaimRecon tools

VA Form 21-22 - Free VSO representation - especially valuable for HLR informal conferences.

Section VI - Signature

1 field

Blocks 12-13Veteran signature and datePII

Sign and date. By signing you certify the statements are true to the best of your knowledge under penalty of perjury.

Example

(signature/date when filing)

Common mistakes

Forgetting to sign - VA returns.

Statutory & regulatory authority

38 CFR 3.400 - Effective date rules including ITF protection of effective date.

38 USC 5104B - HLR statutory authority.

38 USC 5110 - General effective-date rules and ITF protection.

M21-1 VIII.iv.1 - Supplemental, HLR, and Board appeal lane mechanics.