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VA Form 20-0996: Decision Review Request: Higher-Level Review

VA Form 20-0996 asks a more senior VA reviewer to take a new look at your claim based on the evidence already in the file, with no new evidence allowed.

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What is VA Form 20-0996?

VA Form 20-0996, Decision Review Request: Higher-Level Review, is the decision review option for claimants who believe VA got it wrong on the existing record. An experienced reviewer looks at the same evidence de novo and can overturn the decision based on a difference of opinion or a clear error, or return it for correction.

Because the review is limited to the evidence of record at the time of the prior decision, you cannot submit new evidence with this form. You may request an optional informal conference, which is a phone call where you or your representative can point out errors in the decision.

Who files VA Form 20-0996?

Veterans who disagree with a VA decision but have no new evidence to submit
Claimants who believe the decision contains an error on the existing record
Survivors and dependents requesting review of a benefit decision
Representatives requesting Higher-Level Review for a claimant

How to fill out VA Form 20-0996

Enter your identifying information and select the benefit type of the decision.
List each issue you want reviewed and the date of the decision for each.
Choose whether to request an informal conference and provide the contact number for it.
Sign and date the form.
Mail it to the VA Claims Intake Center address in the form instructions, upload it through va.gov, or request a Higher-Level Review online for eligible benefit types.

Quick fill VA Form 20-0996 on this page

Prefer to see the form itself while you type? Open VA Form 20-0996 in the editor to fill it on the actual pages, add a signature, and download.

These are the form's own fields, in the order they appear on the pages. Fill in what you know; anything left blank stays a fillable field in the PDF, so you can finish it in any PDF reader. Nothing you type here is sent to VA.

Page 3 46 fields

6. Check box. I AM HOMELESS OR AT RISK OF HOMELESSNESS.

1. VETERAN'S NAME. Last Name. 18 characters available.

1. VETERAN'S NAME. Middle Initial. 1 character available.

SECTION 1: VETERAN'S IDENTIFICATION INFORMATION. NOTE: You may fill out the form online or by hand. If completed by hand, print the

2. Veteran's Social Security Number. Enter last four numbers.

2. Veteran's Social Security Number. Enter middle two numbers.

2. Veteran's Social Security Number. Enter first three numbers.

3. V. A. File Number (If applicable). Enter nine digit file number.

4. Date of Birth. Enter 4 digit Year.

4. Date of Birth. Enter 2 digit Day.

4. Date of Birth. Enter 2 digit Month.

5. VA INSURANCE POLICY NUMBER (If applicable)

6. CURRENT MAILING ADDRESS. Number and Street. 30 characters available.

6. CURRENT MAILING ADDRESS. ZIP or Postal Code. Enter last 4 digits.

6. CURRENT MAILING ADDRESS. ZIP or Postal Code. Enter first 5 digits.

6. CURRENT MAILING ADDRESS. Country. 2 characters available.

6. CURRENT MAILING ADDRESS. State or Province. 2 characters available.

6. CURRENT MAILING ADDRESS. City. 18 characters available.

6. CURRENT MAILING ADDRESS. Apartment or Unit Number. 5 characters available.

9. Enter Last Name. 18 characters available.

9. Enter Middle Initial. 1 character available.

SECTION 2: CLAIMANT'S IDENTIFICATION INFORMATION. 9. CLAIMANT'S NAME (First, Middle Initial, Last) Enter First Name. 12 characters

10. Claimant's Social Security Number. Enter last four numbers.

10. Claimant's Social Security Number. Enter middle two numbers.

10. Claimant's Social Security Number. Enter first three numbers.

11. Claimant's Date of Birth. Enter 4 digit Year.

11. Claimant's Date of Birth. Enter 2 digit Day.

11. Claimant's Date of Birth. Enter 2 digit Month.

12. CURRENT MAILING ADDRESS. ZIP or Postal Code. Enter last 4 digits.

12. CURRENT MAILING ADDRESS. ZIP or Postal Code. Enter first 5 digits.

12. CURRENT MAILING ADDRESS. Country. 2 characters available.

12. CURRENT MAILING ADDRESS. State or Province. 2 characters available.

12. CURRENT MAILING ADDRESS. City. 18 characters available.

12. CURRENT MAILING ADDRESS. Apartment or Unit Number. 5 characters available.

12. CURRENT MAILING ADDRESS. Number and Street. 30 characters available.

7. TELEPHONE NUMBER (Include Area Code). Enter Area Code.

7. TELEPHONE NUMBER. Enter middle three numbers.

7. TELEPHONE NUMBER. Enter last four numbers.

7. Enter International Phone Number (If applicable).

8. E-MAIL ADDRESS (Optional)

13. TELEPHONE NUMBER (Include Area Code). Enter Area Code.

13. TELEPHONE NUMBER. Enter middle three numbers.

13. TELEPHONE NUMBER. Enter last four numbers.

13. Enter International Phone Number (If applicable).

14. E-Mail Address (Optional)

15. COMPENSATION.

Page 4 39 fields

16. B. IF YOU SELECTED THE BOX ABOVE, VA will make two attempts to contact you OR your representative to schedule the informal conference.

16. B. Check box. Contact the representative. If contact will be by phone, contact in the morning hours based on time zone.

16. B. Check box. Contact the veteran/claimant. If contact will be by phone, contact in the afternoon hours based on time zone.

16. B. Check box. Contact the representative. If contact will be by phone, contact in the afternoon hours based on time zone.

18. A. SPECIFIC ISSUE(S). Line 5 of 13.

18. A. SPECIFIC ISSUE(S). Line 6 of 13.

18. A. SPECIFIC ISSUE(S). Line 7 of 13.

18. A. SPECIFIC ISSUE(S). Line 4 of 13.

18. A. SPECIFIC ISSUE(S). Line 3 of 13.

18. A. SPECIFIC ISSUE(S). Line 1 of 13.

18. A. SPECIFIC ISSUE(S). Line 2 of 13.

17. A. Enter Last Name.

17. IF YOU WOULD LIKE VA TO CONTACT YOUR REPRESENTATIVE, YOU MUST PROVIDE YOUR REPRESENTATIVE'S CONTACT INFORMATION BELOW: 17. A.

18. B. Date of Decision. Enter 4 digit Year.

18. B. Date of Decision. Enter 2 digit Day.

18. B. Date of VA Decision. Enter 2 digit Month.

18. B. Date of VA Decision. Enter 4 digit Year.

18. B. Date of VA Decision. Enter 2 digit Day.

18. B. Date of VA Decision. Enter 2 digit Month.

18. B. Date of VA Decision. Enter 4 digit Year.

18. B. Date of VA Decision. Enter 2 digit Day.

18. B. Date of VA Decision. Enter 2 digit Month.

18. B. Date of VA Decision. Enter 4 digit Year.

18. B. Date of VA Decision. Enter 2 digit Day.

18. B. Date of VA Decision. Enter 2 digit Month.

18. B. Date of VA Decision. Enter 4 digit Year.

18. B. Date of VA Decision. Enter 2 digit Day.

18. B. Date of VA Decision. Enter 2 digit Month.

18. B. Date of VA Decision. Enter 4 digit Year.

18. B. Date of VA Decision. Enter 2 digit Day.

18. B. Date of VA Decision. Enter 2 digit Month.

18. B. Date of VA Decision. Enter 4 digit Year.

18. B. Date of VA Decision. Enter 2 digit Day.

18. B. Date of VA Decision. Enter 2 digit Month.

17. B. REPRESENTATIVE'S TELEPHONE NUMBER (Include Area Code). Enter Area Code.

17. B. TELEPHONE NUMBER. Enter middle three numbers.

17. B. TELEPHONE NUMBER. Enter last four numbers.

SECTION 4 - OPTIONAL INFORMAL CONFERENCE. 16. YOU OR YOUR AUTHORIZED REPRESENTATIVE MAY REQUEST AN INFORMAL CONFERENCE. VA will only

17. C. REPRESENTATIVE'S E-MAIL ADDRESS.

Page 5 32 fields

18. A. SPECIFIC ISSUE(S). Line 10 of 13.

18. A. SPECIFIC ISSUE(S). Line 9 of 13.

18. A. SPECIFIC ISSUE(S). Line 8 of 13.

18. A. SPECIFIC ISSUE(S). Line 13 of 13.

18. A. SPECIFIC ISSUE(S). Line 12 of 13.

18. A. SPECIFIC ISSUE(S). Line 11 of 13.

18. B. Date of VA Decision. Enter 4 digit Year.

18. B. Date of VA Decision. Enter 2 digit Day.

18. B. Date of VA Decision. Enter 2 digit Month.

18. B. Date of VA Decision. Enter 4 digit Year.

18. B. Date of VA Decision. Enter 2 digit Day.

18. B. Date of VA Decision. Enter 2 digit Month.

18. B. Date of VA Decision. Enter 4 digit Year.

18. B. Date of VA Decision. Enter 2 digit Day.

18. B. Date of VA Decision. Enter 2 digit Month.

18. B. Date of VA Decision. Enter 4 digit Year.

18. B. Date of VA Decision. Enter 2 digit Day.

18. B. Date of VA Decision. Enter 2 digit Month.

18. B. Date of VA Decision. Enter 4 digit Year.

18. B. Date of VA Decision. Enter 2 digit Day.

18. B. Date of VA Decision. Enter 2 digit Month.

18. B. Date of VA Decision. Enter 4 digit Year.

18. B. Date of VA Decision. Enter 2 digit Day.

18. B. Date of VA Decision. Enter 2 digit Month.

19. B. Date Signed. Enter 4 digit Year.

19. B. Date Signed. Enter 2 digit Day.

19. B. Date Signed. Enter 2 digit Month.

20. C. Date Signed. Enter 4 digit Year.

20. C. Date Signed. Enter 2 digit Day.

20. C. Date Signed. Enter 2 digit Month.

20. A. Last Name. 18 characters available.

20. A. Name of VA Authorized Representative. First Name. 12 characters available.

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Frequently asked questions

Can I add new evidence with a Higher-Level Review?

No. The reviewer only considers the evidence VA had when it made the prior decision. If you have new evidence, file a Supplemental Claim on VA Form 20-0995 instead.

What is an informal conference?

An optional phone call between the higher-level reviewer and you or your representative. It is a chance to identify specific errors in the decision, not to present new evidence. Requesting one can add time to the review.

When do I have to file?

Generally within one year of the date on the decision notice. A Higher-Level Review is also not available for a decision that was itself a Higher-Level Review; check the current instructions at va.gov.

VA Form 20-0996: Decision Review Request: Higher-Level Review

What is VA Form 20-0996?

Who files VA Form 20-0996?

How to fill out VA Form 20-0996

Quick fill VA Form 20-0996 on this page

Frequently asked questions

Related forms

VA Form 20-0995: Decision Review Request: Supplemental Claim

VA Form 10182: Decision Review Request: Board Appeal (Notice of Disagreement)

VA Form 21-526EZ, Application for Disability Compensation