Updated Nov 27, 2024
In This Chapter |
This chapter contains the following topics:
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1. General Information on Modernized Appeals
Introduction |
This topic contains general information on modernized appeals, including
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Change Date |
April 3, 2024
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4.1.a. Definition: Modernized Appeals (Decision Reviews) |
Public Law 115-55, the Veterans Appeals Improvement and Modernization Act of 2017 (AMA) was signed into law on August 23, 2017, and it became effective on February 19, 2019. AMA provides three choices for claimants dissatisfied with VA’s decisions, including
References: For more information on modernized appeals and the AMA, see
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4.1.d. Differences Between Board Reviews |
The table below shows the differences between the reviews at the Board:
Note: Appellants may seek review of Board decisions by appealing to the Court of Appeals for Veterans Claims (CAVC), or by filing supplemental claims at regional offices. The latter requires either submitting or citing new and relevant evidence. However, claimants may not directly contest Board decisions by requesting HLRs of them. Nevertheless, claimants may request HLRs of RO decisions effectuating Board decisions when granting downstream issues, such as assigning an effective date or evaluation.
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2. Mail Intake Procedures
Introduction |
This topic contains information about AMA mail intake procedures, including:
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Change Date |
April 3, 2024
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4.2.a. Review Lanes of the AMA |
The AMA offers two VBA lanes to claimants for review of their benefits decisions:
Supplemental claims require either the identification or submission of new and relevant evidence, while HLRs consider the evidentiary record as it existed at the time of the prior decision under review.
VA will not review an issue simultaneously pending in another AMA lane, or in any other benefit claim process including a rating claim, non-rating claim, or legacy appeal (absent a request to withdraw the pending issue). A supplemental claim may follow any other type of VBA decision (for example, HLR or effectuating a Board decision). VA will not allow an HLR of a previous HLR or an HLR of a Board decision.
Note: An appellant may contest a Board decision and protect the potential effective date by appealing to CAVC or by submitting a supplemental claim within a year of the Board decision. The latter also requires the submission, or at least citation, of new and relevant evidence.
The AMA maintains the ability of claimants to appeal to the Board, but with significant changes. Previously, the Board retained jurisdiction of appeals from the receipt of the VA Form 9, Appeal to Board of Veterans’ Appeals. However, for decisions issued on or after the February 19, 2019, the effective date of the AMA, the Board assumes jurisdiction of all appeals from the initial notice of disagreement, which is now the VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement).
Reference: For more information on:
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4.2.b. Legacy Appeals Eligible for AMA Participation (Opt-In) |
A claimant may opt-in to the modernized appeals system for any appeal currently in the legacy process for which they have received a Statement of the Case (SOC) or Supplemental SOC (SSOC) dated on or after February 19, 2019. To participate in the modernized appeals system, the claimant must submit a completed application within 60 days from the date of the SOC or SSOC, or within the one-year appeal period from the decision being reviewed, whichever is later. See M21-5, Chapter 4, Topic 2.c.
Note: Once the opt-in election is received and the legacy appeal withdrawn, the claimant may not return to the legacy appeal process from the AMA review.
Important: A claimant may opt into the modernized appeals system for one, some, or all issues currently in the legacy appeals system.
For example, the claimant has three issues pending in the legacy appeal process: service connection for a back condition and a left foot condition, and a request for an increased evaluation for the service-connected anxiety disorder. The claimant receives a SOC for all three conditions. The claimant chooses to opt into the supplemental claim lane in AMA and has identified new and relevant evidence for VA to consider regarding the back and left foot conditions on the completed VA Form 20-0995, Decision Review Request: Supplemental Claim. The service-connected anxiety disorder will remain in the legacy appeal system.
Opting into AMA is issue based, not claim based.
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4.2.c. Acceptable Forms for Seeking Review |
For reviews of decisions issued on or after February 19, 2019, the claimant, or his/her authorized representative, must seek review in writing by submitting either VA Form 20-0996, Decision Review Request: Higher-Level Review, or VA Form 20-0995, Decision Review Request: Supplemental Claim. VBA will not accept review requests in any format other than the prescribed forms.
Forward any VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) to the Board through its Centralized Mail (CM) portal.
Important: For decisions issued prior to February 19, 2019, the legacy appeals process still applies. Accordingly, a claimant seeking review of a compensation decision issued prior to February 19, 2019, must submit a timely VA Form 21-0958 Notice of Disagreement, and may then opt-in to AMA upon receipt of an SOC/SSOC as described above.
Note: A claimant may submit a VA Form 20-0995, Decision Review Request: Supplemental Claim, at any time, including during the legacy appeal period or any time thereafter.
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4.2.d. Time Frames |
To preserve the earliest effective date, VA will generally accept review requests from any eligible claimant, or the authorized representative, who requests a review within one year of the date of the decision. VA must receive an HLR request within one year of the decision notification. However, claimants may submit a supplemental claim at any point after the initial decision. For effective date provisions for decision reviews, please refer to 38 CFR 3.2500.
Reference: For more information on effective dates for claims continuously pursued following a decision of the U.S. Court of Appeals for the Federal Circuit or the Supreme Court of the U.S., see Policy Letter 20-01.
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4.2.e. Placing Review Elections Under Control |
VA receives HLRs and supplemental claims, for compensation and pension issues, through the CM portal.
VA’s HLRs and supplemental claims forms are enterprise-wide and can be used to seek review of any VA claims decision. Accordingly, both forms contain a box for the claimant to select the benefit type. The M21-5 encompasses guidance for compensation and pension benefit claims only. If the claimant requests a benefit type other than compensation, pension, DIC, or survivor benefits, re-route the mail package to the office of jurisdiction in accordance with the Centralized Mail Portal User’s Guide.
When VBA receives an HLR and/or a supplemental claim in the CM portal, intake personnel follow the steps below to place the claim under control. Generally, the intake team will follow the Caseflow instructions to properly input a request for review.
Reference: For more information on intaking supplemental claims filed within one year of a Federal Circuit or Supreme Court decision, see the job aid entitled: Caseflow Intake: Supplemental Claims filed within One-Year of a Court Decision.
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4.2.f. Ineligible HLR Reasons |
Review the VBMS eFolder to determine if the claimant has a prior decision eligible for processing as an HLR.
Important: An HLR of an issue is complete when the reviewer finds an error in the duty to assist (DTA). Supplemental decisions that correct DTA errors do not themselves constitute HLRs, and so are not precluded by an “HLR of an HLR.” Therefore, VA may accept HLRs of decisions returned for development and decided under an EP 040. For example: The claimant files an HLR for a knee condition on September 1, 2020. The reviewer determines there is a DTA error and returns the issue for additional development. Following that development, a rating decision is completed on January 1, 2021, again denying service connection for the knee condition. On February 1, 2021 the claimant files an HLR for the same knee condition. This request can be accepted because the previous decision was directly from the duty to assist return with a different evidentiary record, not an HLR.
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4.2.g. Handling Board Mail When Received With DROC Mail |
When a mixed mail package is received through the CM portal containing AMA decision review requests intended for both the Board and VBA, such as a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), and VA Form 20-0996, Decision Review Request: Higher-Level Review or VA Form 20-0995, Decision Review Request: Supplemental Claim, the VBA intake team should take the steps below.
Note: If mail is received outside of the Centralized Mail Portal, either fax the documentation to 1-844-678-8979 or mail the documentation to
Board of Veterans’ Appeals
PO Box 27063
Washington, DC 20038
Reference: for more information on downloading documents from the CM Portal, please see the Centralized Mail Portal User’s Guide.
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4.2.h. Mail Clarification |
If the DROC receives mail and it is unclear if the material submitted is related to a Board appeal or a decision review, make at least one attempt to contact the claimant or power of attorney (POA) by telephone to clarify the intentions.
If contact is successful, document the claimant’s intent on a VA Form 27-0820, Report of General Information, and upload it into the claimant’s eFolder.
Process the mail and/or forward the mail to the Board for action.
If contact with the claimant is unsuccessful, and the mail packet only includes evidentiary mail, forward the mail to the Board for action. If the mail packet includes AMA claims forms, on which the claimant attempted to select multiple AMA review lanes for the same issue, upload the packet to VBMS – do not reroute the mail packet to the Board (see note at the bottom of this block).
Additionally, use the following text for a permanent note in VBMS:
Mail received on [insert date] and claimant has both a pending decision review and Board appeal. Unable to reach the claimant and/or POA to clarify issues.
If contact is unsuccessful, generate the Clarification of Decision Review Request letter and modify the introduction wording to explain that the correspondence was unclear and to resubmit the claim.
Note: The Clarification of Decision Review Request letter should also be used when DROCs receive decision reviews simultaneously for the same contentions in different lanes.
For example, the Veteran has claimed both a higher-level review and a supplemental claim for posttraumatic stress disorder in one submission. However, if one lane can be clearly eliminated, such as an HLR received outside of a year, or the Veteran very clearly identified new and relevant evidence, allow the Veteran into the appropriate lane and notify the Veteran via letter that we have accepted the claim as an HLR or Supplemental Claim. Advise the Veteran that if this is incorrect, the Veteran should contact VA.
Do not choose a lane for the Veteran if one lane cannot be clearly eliminated. |
4.2.i. Handling Co-Mingled Mail for Other Business Lines |
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If a DROC receives mail pertaining to benefits other than compensation or pension, such as fiduciary, education, insurance, or Veterans Readiness and Employment, the intake team will generally follow the guidance in M21-1, Part II, Subpart i, 2.D.7.a and take the steps below.
Note: The DROCs will completely process all compensation and pension issues that are comingled with HLR and supplemental mail packages. Reference: for more information on downloading documents from the CM Portal, please see the Centralized Mail Portal User’s Guide. |
4.2.j. Folders Excluded From VBMS Processing |
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Appeals and decision reviews are generally available in VBMS for processing. However, certain exceptions do apply. Documents and claims folders that fall under these exceptions should not be sent for scanning. Claims folders that must remain in paper format include
References: For more information on
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4.2.k. Due Process Exceptions Requiring DROC Final Action |
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Due process actions, controlled with EP 600s, are eligible for recall by National Work Queue (NWQ) following establishment, and distributed to the appropriate business line, based on claim attributes. The appropriate claim label for the EP 600 is ncessary based on M21-4, Appendix C to ensure the claim is correctly routed by NWQ. However, the final action on contested claims should be taken by the DROCs upon expiration of the due process period. In order to properly maintain DROC control, DROCs must follow the below, as appropriate:
References: For more information on
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3. Choosing Modernized Decision Reviews on Legacy Appeals
Introduction |
This topic includes general guidance on using appeal decisions, such as SOCs and SSOCs, to solicit elections for reviews and claims under AMA including:
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Change Date |
April 3, 2024
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4.3.a. Choices Under the AMA |
AMA maintains the ability of claimants to appeal to the Board, but proposes significant procedural changes to those appeals. For example, the Board now assumes jurisdiction of all appeals from the initial NOD, as opposed to the previous receipt of a completed VA Form 9, Appeal to the Board of Veterans’ Appeals.
AMA also offers legacy appellants the ability to choose, or opt into, two VBA lanes to review their benefits decisions:
Essentially, HLRs consider the evidentiary record as it existed at the time of the prior decision under review, while supplemental claims require either the identification or submission of new and relevant evidence.
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4.3.b. Using SOCs/SSOCs to Solicit AMA Elections |
The law allows claimants with legacy appeals to opt-in to any of the three AMA review lanes. A legacy appeal stems from any decision (whether from original, new, or reopened claims, or SOCs/SSOCs) VA made before February 19, 2019. Elections to participate in the AMA review programs automatically withdraw associated issues from the legacy Board docket. HLRs and supplemental claims are reviews, rather than Board appeals. Of note, opting-in to an AMA Board appeal lane will remove the appeal from the legacy system and may result in the assignment of a new, and later, AMA docket number. There is no guarantee that an AMA appeal will be decided sooner than the legacy appeal originally pending.
If the claimant opts-in to an HLR or supplemental review, they may later appeal any issues to the Board after VA decides the associated HLRs or supplemental claims, if they disagree with VA’s decisions. However, these are new appeals under the AMA, and would receive new Board docket numbers upon appeal.
Claimants are free to choose various review options when an appeal has multiple issues i.e., claimants may simultaneously opt into different lanes for different issues. However, each issue must have its own distinct lane i.e., a claimant may not pursue the same issue in two different lanes simultaneously. Claimants also may not separate issues that are inextricably intertwined.
A claimant with a legacy appeal has the later of two dates to submit an election for review under AMA:
Reference: For decision reviews simultaneously received for the same contentions in different lanes, see M21-5, Chapter 4, Topic 2.h.
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4.3.c. Informing Appellants of the Options |
When issuing SOCs or SSOCs on or after February 19, 2019, add the following text using the glossary in VBMS:
On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act of 2017 (Appeals Modernization Act), creating a modernized review system for claims and appeals. The modernized appeals system took effect on February 19, 2019, and provides streamlined choices for seeking review of your VA claim decision. You are eligible to opt-in to this new process based on your receipt of this Statement of the Case or Supplemental Statement of the Case. If you continue to disagree with our decision, please refer to the enclosed fact sheet for a more thorough explanation of your decision review options and submission deadlines should you decide to opt-in. If you wish to remain in the legacy process, please follow the instructions above regarding actions required to request further review of your appeal.
Also, ensure the following forms are attached to the SOC/SSOC and listed as enclosures:
Rationale: Unless already of record, enclose VA Form 9 in the event the appellant prefers to perfect the legacy appeal rather than opt for a modernized decision review.
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4.3.d. What VA Requires for AMA Elections |
An election to an AMA review from a legacy appeal must include a completed application for the lane desired (see M21-5, Chapter 4, Topic 3.e), and be submitted within 60 days of an issued Statement of the Case (SOC)/Supplemental Statement of the Case (SSOC).
Once VA receives an application for a decision review within 60 days of an SOC or SSOC, inform the claimant that VA accepted the request for further review and withdrew the legacy appeal.
If the application is received outside of the 60 day window, advise that VA will not take action because another decision on the same issue is pending within the legacy appeal framework.
Reference: For more information on completed applications, see 38 CFR 3.160(a).
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4.3.e. Forms for AMA Lanes |
VA requires the following completed forms from individuals seeking review of the decisions under the AMA.
Refernce: For more information on a complete claim, see 38 CFR 3.160(a).
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4.3.f. Closing Appeals and Establishing AMA Elections |
Follow the prompts in Caseflow to withdraw an issue from a Board appeal after receiving an AMA election. Caseflow will automatically close the Veterans Appeals Controls and Locator System (VACOLS) record. Likewise, follow the prompts in Caseflow to establish the new HLR or supplemental claim resulting from the election solicited by the SOC/SSOC.
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4. Withdrawing or Changing Reviews
Introduction |
This topic contains information on withdrawing and changing a request for decision review, to include:
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Change Date |
April 3, 2024
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4.4.a. Who May Withdraw a Decision Review Requests |
For the purposes of this section, “decision reviews” refers to HLR and supplemental claims. Policy and procedures of the Board govern the withdrawal of AMA appeals (i.e., NODs).
A decision review may be withdrawn, in writing or electronically by
Important: The authority of regional offices or DROCs to withdraw decision reviews is limited to those for which VA has not issued a decision.
References: For more information on
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4.4.b. Requirements for Withdrawing Decision Reviews |
While a request to withdraw a decision review must be submitted either in writing or electronically in a manner prescribed by the Secretary, VA does not require a certain format or form. If the decision review involves multiple issues, the request must either specify that it is withdrawing the decision review in its entirety or list the issue(s) withdrawn.
Notes:
Example: The Veteran has two issues under review – evaluation of arthritis in the right knee and service connection for the left knee. The Veteran submits a written statement that says “Please withdraw the HLR for my knee condition.” Clarification is required to determine which knee condition the Veteran wishes to withdraw.
Reference: For more information on valid electronic signatures, see M21-1, Part II, Subpart i, 2.B.2.g.
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4.4.c. Withdrawal Applies Only to Pending Decisions |
A request to withdraw a decision review is valid only if VA receives it before issuing a decision.
If VA receives a request to withdraw a decision review after issuing a decision notice, inform the claimant of either accepting or renouncing the benefits resulting from VA’s decision. Modify the Decision Review Withdrawal Letter accordingly.
References: For information about
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4.4.d. Procedures for Withdrawing Decision Reviews |
Follow the instructions in the table below when a claimant requests withdrawal of a decision review.
Important: A claimant requesting withdrawal of a decision review that involves multiple contentions should specify which (if not all) of the individual contentions the request affects. If the claimant fails to do so, proceed as if the request applies to all contentions associated with the decision review.
Example: the Veteran has several issues under review and submits a statement that says “Please withdraw my decision review.” The issues are not identified, so VBA should presume that the request applies to all contentions under the HLR.
Note: VA updates Caseflow functionality frequently, so please consult the most recent training for definitive guidance on such topics as removing contentions or changing the type of review.
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4.4.e. Changing Review Lanes |
Claimants or representatives may change the type of decision reviews, whether HLRs or supplemental claims, if VA has not yet decided them. To do so, claimants or representatives must submit both
The following table explains how VA will handle circumstances when it does not receive both elements needed to change review lanes:
Note: Legacy appellants who receive SOCs or Supplemental SOCs may choose to change from the legacy appeals system to the AMA reviews of HLRs or supplemental claims.
References:
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4.4.f. Time Limits for Resubmitting Decision Review Requests |
The claimant or his/her authorized representative may request a decision review after, or in conjunction with, a previous withdrawal.
If VA receives the new decision review request within a year of the decision for which the review is requested,
If the new decision review request is received after a year has passed from the decision in question,
Exception: VA may grant an extension of the one-year period for good cause under 38 CFR 3.109(b), but must receive the supplemental claim application within the extended period.
Follow procedures for establishment of decision reviews under EP 030 or EP 040 as appropriate.
Rationale: VA must receive a request for an HLR within one year of the decision in question. Therefore, after one year, VA will only accept supplemental claims or assertions of clear and unmistakable error.
Reference: For more information on good cause exceptions, see 38 CFR 3.109(b).
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4.4.g. Reinstatement of Erroneously Withdrawn Decision Reviews |
Generally, withdrawing a decision review is final and may not be retracted. However, if VA discovers, either on its own or because of evidence submitted by the claimant, that it erroneously withdrew a review, VA may reinstate it.
In such instances, VA will re-establish the decision review using the appropriate EP and the date of claim will be the date of receipt of the erroneously withdrawn review.
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5. Implementing Actions by the Board of Veterans’ Appeals
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Introduction
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This topic contains information about processing actions of the Board under AMA, including:
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Change Date |
November 29, 2024
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4.5.a. Types of Board Actions |
The Board forwards two types of actions to the Veterans Benefits Administration (VBA) for completion:
Notes:
References: For more information on
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4.5.b. Jurisdiction of Board Actions |
VBA’s DROCs have jurisdiction over all Board compensation grants and remands. The table below explains the general jurisdictions:
Board special issue grants and remands will be routed to the appropriate special mission station:
Note: VA may temporarily assign work outside of these jurisdictions in accordance with workload considerations, so please consult the most recent operational guidance. |
4.5.c. Authority to Implement Board Decisions |
The authority to implement Board decisions belongs to Rating Veterans Service Representatives (RVSRs) or Decision Review Officers (DRO) for rating issues and VSRs for non-rating issues.
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4.5.d. Review of Board Actions |
When VBA receives a Board action, whether a remand or full grant, Caseflow Intake will automatically establish the appropriate EP and claim label based on the following table:
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4.5.e. Generating Decisions |
Decisionmakers will use VBMS-Rating (VBMS-R) to generate decisions on rating issues, with the codesheet documenting all issues addressed within the scope of the appeal, including downstream issues.
Decisionmakers for non-rating/administrative issues will use such letter generating tools as the Redesigned Automatic Decision Letter (RADL) in VBMS-Awards and Personal Computer-Generated Letters (PCGL).
Reference: For more information on RADL, please see M21-1, Part VI, Subpart i, 1.B.3.
When effectuating a grant of service-connection (SC), the medical and lay evidence in the claims folder must be reviewed to determine if it is sufficient to establish the appropriate level of disability evaluation for the period of entitlement covered by the grant of benefits. If the evidence is not sufficient to establish a current evaluation, an adequate examination must be obtained. All evidence of record should be reviewed in the event that a staged rating is required.
Note: If the evidence of record warrants service-connection, but is insufficient to establish an appropriate evaluation for an issue, defer the issue in its entirety and continue the End Product (EP) pending completion of an examination identifying the appropriate evaluation.
When a specific type of medical professional is not available to conduct the C&P examination and/or medical opinion for VA purposes (for example, rural areas or claimants with a foreign address) as directed by the Board, decisions should include documentation of all efforts taken to obtain an examination specialist and explain why the specialist could not be obtained. If VHA or a contract examiner state that another qualified physician is available to complete the examination and/or medical opinion instead, document this response within the memorandum. Decisionmakers should reference the memorandum of record in the Veteran’s file and document the following within the decision:
Refer to the Examination Specialist Unavailable Memorandum template. References: For more information on
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4.5.f. Decision Notices |
VSRs should use RADL to generate the decision notice. If RADL fails to generate a decision notice, then refer to the guidance found in M21-1, Part VI, Subpart i, 1.B.3 to use PCGL to create the notice. Each decision, whether rating or non-rating, must include the notice requirements under AMA.
After VBA complies with the instructions of the remand, it makes a new decision as appropriate and notifies the appellant. VBA should enclose any rating with the decision notice. If the DROC or RO decided any issue downstream of the Board’s grant, such as evaluation or effective date, the DROC or RO should also enclose VA Form 20-0998. Otherwise, refer the appellant to the review rights provided by the Board.
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