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Veterans Health Benefits Appeal

If you have Veterans insurance and your drug or service is denied, you can appeal. An appeal is when you ask your insurance company to change their decision. Like other types of insurance, the VA also has its own appeals process.

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Veterans (VA) Health Benefits Appeal Process

To appeal, you need a written document that says you don’t agree with your local VA office’s decision and you want to appeal. This written document is called a Notice of Disagreement (NOD).

 Include the following information in your NOD:

  • Your name
  • Your address
  • Your phone number
  • Reason(s) why you're appealing
  • The name of the drug or service you want your plan to cover
  • If you have an appointed representative, a copy of the “appointment of representative” form
  • Any other information that may help, including medical records

Send your NOD to the local or regional VA office that denied your request. That office will review your request and make a decision. They will send their decision in writing. This document is called a Statement of the Case (SOC).

If you disagree with the decision in the SOC, you can appeal again. The appeal goes to the Board of Veterans’ Appeals (also called the BVA or the Board) in Washington, D.C. This group will look over all your information and make a decision.

You have 60 days from when your VA office sent you the SOC to do this next level of appeal.

The SOC will give you the steps needed for your appeal. You will need:

  • A copy of the Notice of Disagreement (NOD) you did when you first sent your appeal
  • A completed VA Form 9—Appeal to Board of Veterans’ Appeals form. This should have come with your SOC. If not, you can get a blank form at: Download Form
  • Any additional information that supports your case, such as medical records

HELP WITH YOUR VA HEALTH BENEFIT APPEAL

If you need help, you can give someone permission to be your representative. You can pick a family member, friend, doctor, lawyer or advocate.

To give someone permission to represent you, you need to fill out a VA Form 21-22a Appointment of Individual as Claimant’s Representative form.

Download Form

There are also some Veterans’ Service Organizations or state veterans’ offices that are willing to help. The Directory of Veterans Service Organizations gives you the names of veterans’ service organizations near you that may help.

However, not every organization has been reviewed by the government as able to help you (also called a government accreditation). If you pick an organization to help you, use the following link first to make sure they have a government accreditation to help you.

Visit Website

To give any of these VA organizations permission to help you, you will need to fill out a VA Form 21-22 Appointment of Veterans Service Organization as Claimant’s Representative form. 

Download Form

ADDITIONAL VA APPEAL INFORMATION

At any time during the appeals process, you can ask for a local office hearing where you and a VA hearing officer will meet. This is not required. It just gives you a chance to ask questions and find out if there is any more information you need to send for your appeal.

To set up this meeting, call your local VA regional office. Use this link and click on your state to get the phone number.

Visit Website

For more information on Veterans (VA) Health Benefits appeals, go to:

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