VA Form 20-0995 Example: Supplemental Claim, Filled In Item by Item

Short answer: VA Form 20-0995 is the Supplemental Claim form, which asks VA to decide an issue again because you have new and relevant evidence (or a change in law applies). The current edition is dated May 2024; get it from VA's form page or download the official PDF, or file online for disability compensation. Below are two complete fictional examples, box by box, plus the rules that decide whether your evidence counts and whether you keep your effective date.

The two parts that matter most are Item 21, where you list each issue VA already decided and the date of its decision notice, and Section V, where you attach or identify the new evidence. This fictional example goes through the form in order, including the Item 23 notice box and the legacy-appeal opt-in language that many older examples leave out.

Fictional veteran Jordan Lee received a decision notice dated April 15, 2026 that denied service connection for a right ankle condition. Jordan now has an orthopedic report dated June 2, 2026 that VA has never seen, and wants VA to get records from a private physical therapy clinic. Never copy these invented facts onto a real form.

Item 1: Benefit type

Check one box only. Jordan checks Compensation. If you need reviews for two benefit types, such as compensation and pension, file a separate 20-0995 for each.

Sections I and II: Identification (Items 2 to 19)

Section I (Items 2 to 10) identifies the veteran: name, Social Security number, VA file number, date of birth, service number, insurance policy number if any, mailing address, phone and optional email. Jordan fills in the actual details from Jordan's records. The instructions say VA can identify you with the last name and Social Security or file number even if an address or phone is missing, but complete it anyway.

Section II (Items 11 to 19) is only for a claimant who is not the veteran, such as a surviving spouse, with that person's details and relationship to the veteran. Jordan skips it.

Section III: Homeless information (Items 20A to 20D)

Complete this only if you are homeless or at risk of becoming homeless; VA uses it to prioritize your request. Items 20C and 20D ask for a point of contact. Jordan checks No in 20A and moves on.

Section IV: Issues for the Supplemental Claim (Item 21)

Above the issue lines, Item 21 contains a legacy-appeal statement. If you are answering a Statement of the Case (SOC) or Supplemental Statement of the Case (SSOC) in the old appeals system, filing this form within 60 days of that SOC or SSOC moves the listed issues into the current review system, withdraws them and any hearing requests from the legacy system, and you cannot return. Jordan's decision is a current-system decision, so the statement does not apply.

Copy the issue as the decision notice words it, one line per issue. Only the issues you list are reviewed. For issues you leave off, the instructions say you still have one year from the decision notice to file and keep the earliest effective date. If you are filing within a year of a court decision, the instructions ask you to put the court decision's date in 21B and attach a copy.

Section V: New and relevant evidence (Items 22A to 22D)

"New" means VA has not seen it before, and "relevant" means it tends to prove or disprove something in the claim. Unless your Supplemental Claim is based on a change in law, the form is not complete without new and relevant evidence you submit or identify. The exact definitions are in the section on what counts as new and relevant evidence, below.

Item 22A asks where you were treated. Jordan checks Private health care provider and VA medical center(s) and community-based outpatient clinics. The form's note explains the difference: VA already has access to VA medical center, community clinic and military treatment facility records and needs no consent form, but for private provider records (other than VA-paid community care) or Vet Center records, VA needs VA Forms 21-4142 and 21-4142a. The VA Form 21-4142 example shows how to fill those out.

The form says you do not need to give dates in 22C if treatment began in 2005 or later. Jordan attaches the June 2 orthopedic report directly, with Jordan's name and file number on each page as the form asks, and sends Forms 21-4142 and 21-4142a for the therapy clinic.

Section VI: 5103 notice acknowledgment (Item 23)

This section applies to compensation, pension, Dependency and Indemnity Compensation and accrued-benefit claims. If VA issued the decision you are reviewing within the past year, skip it. If the decision is more than a year old, read VA's page on the evidence needed for a disability claim, which is the notice required by 38 U.S.C. 5103, and check Yes to certify you reviewed it. If you check No, VA mails you the notice instead. Jordan's decision is under a year old, so Jordan skips Item 23.

Section VII: Notifying VA health care (Item 24)

Item 24 applies only to a compensation claim for a condition tied to military sexual trauma when you are enrolled in VA health care. It lets you consent, decline or revoke consent for the benefits office to alert VA health care about upcoming exams, Board hearings and decision notices. A response is not required. Jordan checks D, not applicable.

Sections VIII to XI: Signatures (Items 25 to 29)

Jordan signs Item 25A and dates 25B. Section IX (Items 26 and 27) is for two witnesses only if the claimant signs with an "X." Section X (Item 28) is for an alternate signer, who needs VA Form 21-0972 on file. Section XI (Items 29A to 29D) is for a representative's signature, which VA accepts only if a current VA Form 21-22 or 21-22a is on record.

Make the evidence answer the denial reason

A report that is newer but repeats what VA already knew may not change anything. Put the denial reason beside what the new record says:

Medical opinions show why this matters. In Claim Raven's analysis of 2024 to 2025 Board decisions, condition records where the Board described the medical opinion as strong were favorable 89.7% of the time, compared with 3.7% where it described the opinion as weak. The Board's quality rating partly reflects its own conclusion, and these are already-disputed appeals, so the figures describe what the Board rewards, not your odds; the full breakdown is on Claim Raven's VA disability statistics page. The new and relevant evidence examples show what qualifies.

What counts as new and relevant evidence

The rule is 38 C.F.R. 3.2501. Paragraph (a)(1) defines both words:

• New evidence is evidence that was not previously part of the actual record before VA's adjudicators. A fresh copy of a record VA already had is not new.
• Relevant evidence is information that tends to prove or disprove a matter at issue in the claim. The regulation adds that relevant evidence includes evidence that raises a theory of entitlement VA did not address before.

The same section adds four points that matter when you fill out Section V:

1. The new and relevant standard is not a higher bar than the old "new and material" standard (3.2501(a)).
2. VA counts VA treatment records you reasonably identify, and evidence it received while the record was closed, such as evidence sent during a Higher-Level Review (3.2501, opening paragraph).
3. A substantially complete Supplemental Claim triggers VA's duty to help you gather the new evidence you identify (3.2501(c)).
4. If no new and relevant evidence is presented or secured, VA issues a decision finding there was not enough evidence to decide the claim again.

VA's Supplemental Claim page gives two examples that fit: a new medical report linking a condition to a service-connected injury, and a buddy statement from someone who saw the in-service incident.

How filing within one year protects your effective date

You can file a Supplemental Claim at any time after a decision (38 C.F.R. 3.2500(a)(2)), but timing decides the effective date, the date VA pays from if it grants the claim.

• Within one year. Paragraph 3.2500(c) lets you "continuously pursue" an issue by filing an allowed review after each decision. Paragraph 3.2500(h)(1) says that if you file each review within one year of the decision, the effective date is set from the date VA received your initial claim or the date entitlement arose, whichever is later. The statute behind it is 38 U.S.C. 5110(a)(2).
• After one year. Paragraph 3.2500(h)(2) says a Supplemental Claim received more than a year after the decision notice gets an effective date no earlier than the date VA received the Supplemental Claim.
• Switching late breaks the chain. Under 3.2500(e)(2), if you withdraw another review and switch to a Supplemental Claim after the one-year period, continuous pursuit is broken unless VA grants a good-cause extension.

For Jordan, a Supplemental Claim filed within one year of the April 15, 2026 notice keeps the chain back to the original claim.

Intent to file and Supplemental Claims after Hoffman v. Collins

An intent to file, such as one made on VA Form 21-0966, holds a possible start date for a claim for one year. The printed text of 38 C.F.R. 3.155 still says the intent to file rule does not apply to Supplemental Claims, but, as the Veterans Court explained, the Federal Circuit struck down that exclusion in 2021 in Military-Veterans Advocacy v. Secretary of Veterans Affairs.

On August 24, 2026, the Veterans Court decided Hoffman v. Collins, No. 24-7834. The veteran filed an intent to file in February 2023, a Supplemental Claim in May 2023 on issues denied less than a year earlier, and new claims in July 2023. VA treated the May Supplemental Claim as using up the intent to file, so the new claims got a July date. The court held:

• A Supplemental Claim filed within a year of the denial is continuously pursued, and the statute already gives it the date of the initial application, so tying an intent to file to it adds nothing.
• VA may not apply 38 C.F.R. 3.155(d)(1)(ii) to associate a continuously pursued Supplemental Claim with an intent to file when that gives no effective-date benefit. In the court's words, the earlier Federal Circuit decision "requires filers of supplemental claims to have access to the ITF framework when the ITF can benefit them."
• For Mr. Hoffman, the court ordered a February 28, 2023 effective date for stroke residuals and sent the erectile dysfunction and related special monthly compensation dates back for more fact-finding.

The practical point is narrow: if you filed an intent to file, then a timely Supplemental Claim, then a new claim within the same year, VA should not use up the intent to file on the Supplemental Claim. The decision does not change the one-year rule in 3.2500(h). Claim Raven's Hoffman v. Collins explainer walks through the filing sequence, and the free intent to file date checker lines up your dates. The court's docket shows judgment entered on September 15, 2026.

Second example: a secondary condition denied for no link

Fictional veteran Alex Moreno is service connected for a right knee condition. Alex claimed a low back condition as secondary to the knee in a claim VA received on September 12, 2025. A decision notice dated March 3, 2026 denied it because no medical evidence linked the back to the knee. Under 38 C.F.R. 3.310, a disability caused by a service-connected condition, or made worse by one, can be service connected. Alex's private orthopedist reviewed the records, examined Alex and wrote an opinion dated September 22, 2026 explaining why the knee caused or worsened the back condition. VA has never seen it. These facts are invented.

Alex does not need Forms 21-4142 and 21-4142a, because Alex is attaching the private opinion rather than asking VA to request records from that doctor. Alex's evidence table looks like this:

Because Alex files within one year of the March 3, 2026 notice, a grant would take its effective date from the September 12, 2025 claim or the date entitlement arose, whichever is later, under 3.2500(h)(1). For how secondary claims work and what a medical opinion should cover, see Claim Raven's pages on secondary service connection and nexus letters.

Timing and where to send it

You can file a Supplemental Claim at any time, but VA's decision review FAQ recommends filing within one year of the decision letter to keep your effective date. For disability compensation you can file online. On paper, use the mailing address on page 1 of the form for your benefit type; for compensation it is Department of Veterans Affairs, Compensation Intake Center, P.O. Box 4444, Janesville, WI 53547. The form also accepts submission in person at a regional office or upload through QuickSubmit. Keep a copy of the form, the attachment list and the confirmation.

If you want a cover letter that explains the new evidence, Sample 1 in the appeal letter samples is written for a Supplemental Claim. If you are not sure the Supplemental Claim is the right review, the comparison of review options sets out the evidence rules for each, and the VA Form 20-0996 example and VA Form 10182 example walk through the other two forms.

To find the exact denial reason in a long letter, Claim Raven's Raven Eye reads a VA decision letter or Disability Benefits Questionnaire and shows the reason VA gave, the dates, and the gaps to address. Each account gets one free starter analysis. Claim Raven sells this tool. It does not file anything or decide whether VA is right. Free help from an accredited Veterans Service Organization is also available through Find a VSO.

Sources and scope

Checked November 8, 2026: VA Form 20-0995 (VA's form page lists the May 2024 revision; the PDF is marked May 2024 and supersedes the September 2022 edition) and its printed instructions, VA's Supplemental Claim page and decision review FAQ, 38 C.F.R. 3.155, 3.2500, 3.2501 and 3.310 on eCFR, and the Veterans Court's Hoffman v. Collins opinion. Board figures come from Claim Raven's analysis of 2024 to 2025 decisions and count condition records. Jordan Lee, Alex Moreno and every entry above are fictional.

VA Form 20-0995 questions