What to Do After a VA Rating Increase Denial

Don't Panic—You Have Options

Receiving a denial for your rating increase can be disheartening, especially when you know your condition has worsened. But a denial isn't the end of the road—it's just the beginning of the appeals process. Under the Appeals Modernization Act (AMA), you have multiple pathways to challenge the denial and get the rating you deserve.

The key is understanding your options, choosing the right path based on why you were denied, and acting strategically to maximize your chances of success while protecting your effective date. Many veterans win on their first appeal—or second, or third. Persistence, combined with strong evidence and the right strategy, often leads to eventual approval.

Understanding Your Denial Letter

Before deciding your next step, carefully read your denial letter. Understanding why you were denied is critical to choosing the right appeal strategy.

Common Reasons for Increase Denials

1. Insufficient evidence of worsening: The VA found that your evidence doesn't show your condition has worsened since your last rating

2. Current symptoms don't meet higher criteria: Your condition hasn't worsened enough to meet the next rating level in 38 CFR

3. C&P exam doesn't support increase: The examiner's findings don't show increased severity

4. Evidence shows improvement: Medical records indicate your condition has improved (rare but possible)

5. Inadequate medical evidence: Insufficient recent treatment records, no medical opinion, or gaps in documentation

6. Rating criteria misunderstanding: You believe you meet higher criteria, but the rater interpreted them differently

7. Missing nexus for secondary: If claiming secondary worsening, insufficient evidence linking increased symptoms to service-connected condition

What to Look For in Your Decision Letter

• Reasons and bases: The explanation of why your claim was denied

• Evidence considered: What records and exams the rater reviewed

• Rating criteria applied: Which diagnostic code and criteria were used

• C&P exam results: What the examiner found and concluded

• Decision date: This starts your one-year clock for preserving effective date

• Appeal options: The letter should explain your three options (Supplemental Claim, HLR, Board Appeal)

Identifying Errors vs. Insufficient Evidence

This distinction determines your best appeal path:

Errors (Best for HLR)

• Rater misapplied rating criteria

• C&P examiner didn't review records

• Decision ignored favorable evidence

• Rater used wrong diagnostic code

• Mathematical errors in combined rating

• VA failed duty to assist

Insufficient Evidence (Best for Supplemental)

• Need recent treatment records

• Need private medical opinion

• Need buddy statements

• Need to document functional limitations better

• Need updated C&P exam

• Need to prove worsening more clearly

Your Three Appeal Options

Option 1: Supplemental Claim (Most Common)

What it is: File a new claim with new and relevant evidence

Timeline: 6-8 months average

Success rate: 35-40% with strong new evidence

Deadline: No deadline, but file within one year to potentially preserve effective date

When to choose Supplemental Claim:

• You have or can obtain new evidence showing worsening

• Your denial cited insufficient evidence

• You need a new C&P exam because the previous one was inadequate

• You've developed new secondary conditions or additional symptoms

• You can get a private medical opinion supporting your case

• You want the highest chance of success

What qualifies as "new and relevant" evidence:

• Medical records dated after your last decision

• Private medical opinion addressing why you meet higher criteria

• New buddy statements from family describing worsening

• Employment records showing you had to quit or reduce hours

• Hospitalization records

• Updated diagnostic test results (MRI, X-ray, sleep study, etc.)

• Evidence that existed before but wasn't submitted (technically allowed under AMA)

Advantages of Supplemental Claim:

• Highest success rate because you're strengthening your case

• VA will order new C&P exam if warranted

• Can be filed repeatedly with new evidence

• If filed within one year, may preserve effective date

• No need to prove legal errors—just show new evidence

Option 2: Higher-Level Review

What it is: Senior rater reviews existing evidence for errors

Timeline: 4-5 months average

Success rate: 15-25% (lower because no new evidence)

Deadline: One year from decision date

When to choose Higher-Level Review:

• The rating criteria were clearly misapplied to your documented symptoms

• The C&P examiner made factual errors or didn't review your records

• The rater ignored favorable evidence in your file

• You believe the VA failed its duty to assist

• You're approaching the one-year deadline and don't have new evidence yet

• You want a faster decision (preserves effective date if you win)

• You don't want to risk a new C&P exam

Key features:

• No new evidence allowed: Only reviews what was in your file at the time of decision

• Informal conference option: You can request a phone call to explain the errors to the senior rater

• Preserves effective date: If you win, your effective date goes back to your original claim

• Different rater: Reviewed by someone who wasn't involved in original decision

Best HLR Scenarios:

• Your symptoms clearly meet 50% criteria but you were rated 30%

• C&P examiner stated they didn't review your records

• Rater used wrong diagnostic code or formula

• Decision letter ignored buddy statements or key medical evidence

• VA should have ordered additional development but didn't

Option 3: Board of Veterans Appeals

What it is: Appeal to a Veterans Law Judge

Timeline: 12-36+ months depending on docket choice

Success rate: Varies widely by case and docket

Deadline: One year from decision date

Three Board dockets:

1. Direct Review (fastest, 12-18 months): Judge reviews existing record only, no new evidence or hearing

2. Evidence Submission (18-24 months): Can submit evidence within 90 days of filing, no hearing

3. Hearing (24-36+ months): Can submit evidence within 90 days AND have a hearing with the judge

When to choose Board Appeal:

• You've already tried Supplemental Claim and/or HLR without success

• Your case involves complex legal issues requiring a judge's interpretation

• You want a hearing to present your case in person

• You have strong evidence but need a decision-maker who will carefully review everything

• You're willing to wait longer for a potentially more favorable review

Important: Most veterans should try Supplemental Claim or HLR before going to the Board. The Board is best reserved for cases that have been through at least one review at the regional office level. However, if you're confident in your case and have strong evidence, the Board's Evidence Submission docket can be a good option.

Decision Matrix: Which Path Should You Choose?

Scenario: Denied due to "insufficient evidence of worsening"

Best Choice: Supplemental Claim

Why: You need to strengthen your evidence package. Get recent treatment records, private medical opinion, updated buddy statements, and evidence of increased functional limitations.

Action Plan: Spend 2-3 months gathering comprehensive evidence, then file Supplemental Claim with clear explanation of how your evidence shows worsening.

Scenario: Your symptoms clearly meet 70% criteria but VA rated you 50%

Best Choice: Higher-Level Review

Why: This is a rating criteria error. Your existing evidence supports the higher rating, but it was misapplied.

Action Plan: File HLR, request informal conference, and walk the senior rater through how your documented symptoms meet each element of the 70% criteria in 38 CFR.

Scenario: C&P examiner stated "veteran reports worsening but exam is normal"

Best Choice: Supplemental Claim

Why: You need new evidence to overcome the C&P exam findings. A private medical opinion explaining why your condition is worse than the exam showed, plus buddy statements about functional limitations, can be powerful.

Action Plan: Get private IME from a specialist who spends adequate time evaluating you. Include buddy statements describing limitations the C&P examiner didn't capture.

Scenario: You're at month 11 after denial and still gathering evidence

Best Choice: File HLR now, continue gathering evidence for later

Why: Preserve your effective date with the faster HLR. If it's denied, immediately file Supplemental Claim with your newly gathered evidence.

Action Plan: File HLR by the one-year mark. While it's pending (4-5 months), gather comprehensive evidence. If HLR is denied, file Supplemental Claim immediately.

Scenario: Denied twice (Supplemental Claim then HLR both denied)

Best Choice: Board of Veterans Appeals (Evidence Submission or Hearing docket)

Why: You've exhausted regional office reviews. A Veterans Law Judge may give your case the detailed review it needs.

Action Plan: File Board Appeal. Consider hiring an accredited attorney who specializes in Board representation. Submit comprehensive brief explaining why you meet the higher rating criteria.

Protecting Your Effective Date

Understanding effective dates is critical to maximizing your back pay:

The One-Year Rule

If you file a Supplemental Claim within one year of your denial and win, your effective date may go back to your original claim date. After one year, your effective date is the date you filed the Supplemental Claim—potentially costing you thousands in back pay.

How Each Option Affects Effective Date

Supplemental Claim (filed within 1 year):

If approved, effective date may go back to original claim. However, the VA interprets "new and relevant" evidence conservatively—if your evidence was available at the time of original claim but you didn't submit it, they may not grant the earlier effective date.

Supplemental Claim (filed after 1 year):

Effective date is the date you file the Supplemental Claim. You lose the intervening months of benefits.

Higher-Level Review:

If approved, effective date goes back to your original claim date. This is a major advantage of HLR—you preserve the earliest possible effective date if you win.

Board Appeal:

If approved, effective date goes back to your original claim date (or the date of the claim that led to the appeal).

Strategic Timing

If you're approaching the one-year deadline:

• Option A: File HLR to preserve effective date (faster decision), while simultaneously gathering evidence for potential future Supplemental Claim if HLR is denied

• Option B: File Supplemental Claim with whatever evidence you have now, then continue submitting additional evidence via QuickSubmit as you gather it

• Don't do: Wait past the one-year mark hoping to gather perfect evidence—you may lose thousands in back pay

Building a Winning Appeal

For Supplemental Claims

1. Identify what was missing: Review your denial letter to understand what evidence the VA found insufficient

2. Gather targeted evidence: Obtain specific evidence addressing the VA's concerns

   Recent treatment records (last 6-12 months)

   3. Private medical opinion addressing rating criteria

   4. Updated buddy statements with specific examples

   5. Evidence of functional decline

3. Write a cover letter: Explain what new evidence you're submitting and how it shows worsening

4. Address the rating criteria directly: Show how your current symptoms meet each element of the higher rating level

5. Submit everything at once: Don't piecemeal your evidence—submit a complete package

For Higher-Level Reviews

1. Identify specific errors: Point out exactly where the rater went wrong

   "The rater applied the 30% criteria when my exam showed symptoms meeting 50% criteria"

   2. "The C&P examiner stated they did not review my treatment records before concluding no worsening"

   3. "The decision ignored my buddy statement from my spouse describing daily panic attacks"

2. Request an informal conference: This phone call with the senior rater is your chance to explain the errors

3. Prepare for the conference: Have your file, rating criteria, and specific examples of errors ready

4. Be specific and factual: Focus on objective errors, not emotional appeals

For Board Appeals

1. Choose your docket carefully: Direct Review (fastest), Evidence Submission (can submit evidence), or Hearing (can present in person)

2. Consider hiring an attorney: Board appeals benefit from legal expertise. Accredited attorneys work on contingency (20-33% of past-due benefits)

3. Submit a written brief: Detailed explanation of why you should be granted the higher rating

4. If choosing hearing docket: Prepare thoroughly, practice your testimony, bring witnesses if helpful

5. Submit all evidence within 90 days: If using Evidence Submission or Hearing docket, you have 90 days from filing to submit evidence

Common Mistakes to Avoid

Mistake: Filing the same claim with the same evidence

This will result in another denial. If filing a Supplemental Claim, you MUST have new evidence. If you're arguing errors with the same evidence, file an HLR instead.

Mistake: Missing the one-year deadline unnecessarily

Don't let the one-year mark pass while you're "still gathering evidence." File something—HLR, Supplemental Claim with partial evidence, or Board Appeal—to preserve your effective date. You can continue developing evidence after filing.

Mistake: Giving up after one denial

Many eventually successful claims are denied multiple times before approval. Each denial teaches you what evidence or arguments you need. Persistence is key.

Mistake: Filing multiple appeals for the same issue simultaneously

You cannot file both an HLR and Supplemental Claim for the same condition at the same time. Choose one path. However, you CAN appeal different conditions simultaneously.

Mistake: Not reading the denial letter carefully

Your denial letter contains critical information about what was wrong with your claim. Read it multiple times. Understand exactly why you were denied before choosing your appeal strategy.

When to Get Professional Help

While you can appeal on your own, certain situations benefit from professional assistance:

Consider a VSO (Veterans Service Organization) if:

• You're unsure which appeal path to choose

• You need help obtaining or interpreting medical records

• You want help preparing for an HLR informal conference

• You need guidance on what evidence to gather

• Cost: VSOs are completely free

Consider an accredited attorney if:

• Your claim has been denied multiple times

• You're filing a Board Appeal

• Your case involves complex legal issues

• You need to obtain a private medical opinion (some attorneys advance this cost)

• Large amounts of back pay are at stake (100% rating, many years of benefits)

• Cost: Attorneys work on contingency, typically 20-33% of past-due benefits (not future monthly benefits). If you don't win, you don't pay.

When to hire: Many veterans successfully handle their own Supplemental Claims and HLRs. Consider professional help once you reach the Board level, have been denied multiple times, or when the amount at stake justifies the attorney's fee.

Quick Action Guide

Immediately After Denial:

1. Read your decision letter thoroughly (multiple times)

2. Note your decision date and mark your calendar for the one-year deadline

3. Identify why you were denied (insufficient evidence vs. legal error)

4. Determine what evidence you need or what errors were made

5. Decide which appeal path is best for your situation

Within 30 Days:

• Begin gathering evidence (for Supplemental Claim)

• Request C&P exam recording if you want to review what was said

• Consult with VSO or attorney if needed

• Start drafting your appeal arguments

Within 90 Days:

• Have a clear plan for which appeal path you'll take

• Continue evidence gathering if filing Supplemental Claim

• Prepare informal conference arguments if filing HLR

By 10-11 Months (If Still Preparing):

• File something to preserve your effective date—even if your evidence isn't perfect

• You can submit additional evidence after filing via QuickSubmit

• Don't let the one-year deadline pass while still gathering evidence

Final Thoughts

A denial is not a final answer—it's an opportunity to strengthen your case and try again. Many veterans who are eventually rated 100% were denied multiple times before winning. The difference between those who succeed and those who give up is persistence, strategy, and willingness to gather the evidence needed to prove their case.

Your choice of appeal path matters, but what matters more is the quality of your evidence and arguments. Whether you file a Supplemental Claim with strong new evidence or an HLR pointing out clear errors, focus on building the strongest possible case for why you deserve the higher rating.

Remember: The VA denies claims that lack sufficient evidence or proper application of the law. Your job is to provide that evidence or identify those errors. With the right approach, most denials can eventually be overturned. Don't give up on the rating you've earned.