Understanding VA Appeals Under the AMA: Options, Pros, Cons, and How to Avoid Common Mistakes

The Appeals Modernization Act (AMA), implemented in 2019, transformed the way veterans appeal VA disability claim denials. Under the AMA, veterans now have three different options to appeal an unfavorable decision: Supplemental Claim, Higher-Level Review, and Board of Veterans’ Appeals (BVA) Appeal. Each option has its own advantages, disadvantages, and specific requirements.

In this guide, we’ll explore each of these appeal options, the pros and cons of each, and the common mistakes veterans make during the appeals process—and how to avoid them.

Appeal Options Under the AMA: A Closer Look

The AMA gives veterans more flexibility and control over their appeals. Here’s a breakdown of the three primary options for appealing a VA decision under the AMA:

1. Supplemental Claim A Supplemental Claim allows veterans to submit new and relevant evidence that was not included in the original claim. The VA will review the new evidence and reconsider the decision. This process typically takes around 125 days.
   • Pros:
     • You can submit new evidence that was previously unavailable.
     • The process is relatively quick, with decisions often made in four to five months.
     • You maintain the effective date of your original claim, which can lead to retroactive benefits if approved.
   • Cons:
     • You must submit new and relevant evidence; otherwise, the VA may deny the claim again.
     • The decision will be based only on the new evidence you provide, not on a full re-review of your case.
   • Common Mistakes and Pitfalls:
     • Not providing substantial new evidence: A common mistake veterans make is submitting a Supplemental Claim without new and relevant evidence. The VA will only reconsider your case if the new evidence directly addresses the reasons for the original denial. Be sure to submit updated medical records, new nexus letters, or any documentation that wasn’t previously considered.
     • Missing the one-year deadline: You have one year from the date of the VA’s decision to file a Supplemental Claim. Missing this deadline means losing the opportunity to preserve the effective date and the chance for retroactive benefits.
2. Higher-Level Review The Higher-Level Review option provides a fresh look at your case by a more experienced VA adjudicator, but it does not allow for new evidence to be submitted. Instead, the reviewer will re-examine your claim to determine if any errors were made during the initial decision. On average, Higher-Level Reviews are resolved within 90 to 120 days, making this one of the faster appeal options.
   • Pros:
     • The review is conducted by a more experienced VA employee who may spot errors in the original decision.
     • It’s a relatively quick process, often resulting in a decision within three to four months.
     • You have the option to request an informal conference with the reviewer to explain your case and address any misunderstandings.
   • Cons:
     • No new evidence can be submitted, meaning the review is based solely on the information that was in your original claim.
     • If there was no clear error in the original decision, the denial may be upheld.
   • Common Mistakes and Pitfalls:
     • Choosing Higher-Level Review without new evidence: If your case lacks sufficient evidence, a Higher-Level Review might not be the best choice. If you have new medical evidence or documentation, it may be better to submit a Supplemental Claim.
     • Not taking advantage of the informal conference: Veterans often overlook the importance of the informal conference. This meeting allows you to directly communicate with the reviewer, which could make a big difference in how your case is understood. Be prepared to explain your condition, clarify any discrepancies, and emphasize critical points.
   • Real Stats: In 2022, the VA reported that 33% of cases were overturned or partially overturned during Higher-Level Review, meaning veterans who used this option had a substantial chance of success if errors were present in their original decisions.
3. Board of Veterans’ Appeals (BVA) Appeal A BVA Appeal offers a more in-depth review of your case by a Veterans Law Judge (VLJ). You have the option to choose between three types of review:
   • Direct Review: No new evidence is submitted, and the Board reviews your claim as it stands.
   • Evidence Submission: New evidence is submitted for the Board to consider.
   • Hearing: You can request a hearing with a Veterans Law Judge to present your case in person or via video conference. On average, BVA appeals take between 12 to 18 months to resolve, but timelines may be longer depending on the complexity of the case.
   • Pros:
     • Provides a thorough review of your claim by a Veterans Law Judge who specializes in handling complex cases.
     • You have the option to present new evidence or request a hearing to explain your case directly to a judge.
     • If successful, the decision could result in back pay dating back to your original effective date.
   • Cons:
     • The process can be lengthy, often taking more than a year to receive a decision.
     • There’s no guarantee of success, even with new evidence or a hearing.
   • Common Mistakes and Pitfalls:
     • Not preparing adequately for a BVA hearing: Veterans sometimes assume that attending a hearing guarantees a favorable outcome. However, preparation is key. Make sure to gather and submit all relevant evidence well in advance and practice explaining how your condition affects your life.
     • Failing to submit new evidence for evidence submission reviews: If you opt for the evidence submission lane, ensure you’re submitting clear and relevant new evidence that directly addresses the reasons for your denial. Veterans who submit weak or irrelevant evidence may see little to no impact on their appeal.
   • Real Stats: According to the VA’s 2023 Annual Report, approximately 33% of BVA appeals resulted in favorable decisions for veterans, while an additional 23% were remanded (sent back for further review). This shows that veterans who appeal to the BVA have a 56% chance of either winning their appeal or having it reconsidered.

How to Choose the Best Appeal Option for Your Case

Deciding which appeal option is right for you depends on several factors, including whether you have new evidence, the complexity of your case, and how quickly you need a decision. Here’s how to determine the best path:

1. Choose Supplemental Claim If:
   • You have new evidence that directly addresses the VA’s reasons for denying your claim (e.g., updated medical records, a nexus letter).
   • You want to retain the original effective date, which could lead to a significant retroactive payment.
2. Choose Higher-Level Review If:
   • You believe the VA made an error in reviewing your claim, such as overlooking key evidence or misunderstanding medical records.
   • You don’t have new evidence but want a senior VA reviewer to take a fresh look at your case.
   • You would benefit from an informal conference to discuss your case and clarify any misunderstandings.
3. Choose BVA Appeal If:
   • Your case involves complex legal or medical issues that require more detailed consideration.
   • You want to submit new evidence or attend a hearing to explain your case to a Veterans Law Judge.
   • You’re willing to wait for a longer decision process but want a thorough review of your claim.

Avoiding Common Pitfalls in the VA Appeals Process

The VA appeals process can be overwhelming, and many veterans make mistakes that delay their appeals or reduce their chances of success. Here’s how to avoid common pitfalls:

1. Not Meeting Deadlines Missing important deadlines is one of the most common reasons veterans lose the chance to appeal a VA decision. Veterans have one year from the date of the decision to submit an appeal.
   • How to Avoid It: Stay organized, set reminders, and submit your appeal as soon as possible. If you’re working with an attorney or representative, they can help ensure you meet all deadlines.
2. Not Submitting Strong Evidence (for Supplemental Claims or BVA Appeals) If you choose to file a Supplemental Claim or submit new evidence for a BVA appeal, it’s crucial that your evidence directly addresses the VA’s reasons for denial. Submitting weak or irrelevant evidence won’t improve your chances.
   • How to Avoid It: Carefully review the VA’s denial letter to identify what evidence is missing and gather updated medical records, nexus letters, or witness statements to fill those gaps.
3. Not Preparing for a BVA Hearing Veterans who opt for a BVA hearing may mistakenly believe that showing up is enough to win their appeal. However, the hearing is a critical opportunity to present your case clearly and persuasively.
   • How to Avoid It: If you request a hearing, make sure to work with a VA-accredited attorney who can help you prepare. Thoroughly review your medical records and practice presenting your case to ensure you’re ready.

Why Working with Disability Law Group Is Key to a Successful Appeal

Filing an appeal with the VA can be a complex and overwhelming process, but you don’t have to do it alone. At Disability Law Group, we specialize in guiding veterans through the appeals process and helping them secure the benefits they’ve earned. Our VA-accredited attorneys are experienced in all three appeal options under the AMA and can help you choose the best path for your case.

We’ll work closely with you to gather the necessary evidence, ensure all forms are submitted on time, and represent you during hearings or informal conferences. Let Disability Law Group help you navigate the appeals process with confidence and ensure that you get the compensation you deserve.