VA Form 20-0996 asks a more senior VA reviewer to look again at an issue VA already decided, using only the evidence that was in the file when VA sent the decision notice. The current edition is dated March 2024. The form is short: identify yourself, pick one benefit type, decide whether you want an informal conference, list each issue with its decision date, and sign. This fictional example goes through it in order.
Fictional veteran Casey Rivera received a decision notice dated June 10, 2026 denying service connection for a left wrist condition. Casey believes VA missed a service treatment record that was already in the file and has no new evidence to add. If the missing piece were a new medical report, a Higher-Level Review (HLR) would be the wrong review, because it cannot consider evidence received after the decision. Never copy these invented facts onto a real form.
Section I: Veteran's identification (Items 1 to 8)
Items 1 to 8 ask for the veteran's name, Social Security number, VA file number, date of birth, VA insurance policy number if any, mailing address, phone and optional email. Item 6 has a box to check if you are homeless or at risk of homelessness. The instructions add that you can file VA Form 20-10207 with this form to ask for priority processing for other reasons. Casey fills in Casey's own details and leaves the box unchecked.
Section II: Claimant's identification (Items 9 to 14)
Complete this only if the claimant is not the veteran, such as a surviving spouse, or a health care provider asking for review of a VA payment decision. Casey skips it.
Section III: Benefit type (Item 15)
Check only one. Casey checks Compensation. If you disagree with decisions in two benefit types, file a separate 20-0996 for each; every issue on one form must belong to the benefit type checked here.
Section IV: Optional informal conference (Items 16A to 17C)
| Item | What it asks | Casey's fictional entry |
|---|---|---|
| 16A | Check to request one informal conference. The box states that you cannot discuss or introduce evidence that was not in your file at the time of the decision, that VA may decide faster without a conference, and that VA may contact you by mail, phone, electronic notice or other means to schedule it. | Checked |
| 16B | Contact preference: you or your representative, by phone in the morning or the afternoon in your time zone | Contact the veteran, afternoon |
| 17A to 17C | Your representative's name, phone and email, if VA should contact the representative | Blank, because Casey has no representative |
The instructions say VA makes two attempts to reach you or your representative; if both fail, the reviewer decides without the conference. VA's HLR page adds that VA may email or text a scheduling link. For VA to speak with a representative, a VA Form 21-22 or 21-22a must be on record or included. The instructions also offer an alternative: skip the conference and attach a written statement that points out VA's misreading of the facts or misapplication of the law, which can avoid delay. How to prepare for the call itself is covered in the guide to the HLR informal conference.
Section V: Issues for Higher-Level Review (Items 18A and 18B)
Item 18 begins with a legacy-appeal statement. If you are responding to 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 withdraws the listed issues and any hearing requests from the legacy system and moves them into Higher-Level Review, and you cannot return to the legacy system for them. Casey's decision is in the current system, so the statement does not apply.
| Item | What it asks | Casey's fictional entry |
|---|---|---|
| 18A | Specific issue of disagreement (required) | Service connection for left wrist condition |
| 18B | Date of VA decision notification letter (required) | 06/10/2026 |
List each issue on its own line with the date of VA's most recent decision on it, using the decision letter's wording. Only the issues you list are reviewed. If you need more room, attach pages with your name and file number on each.
Section VI: Certification and signature (Items 19A and 19B)
Casey signs 19A and dates 19B. The instructions recommend not signing in pencil. If someone else must sign for you, include VA Form 21-0972, Alternate Signer Certification.
Section VII: Authorized representative signature (Items 20A to 20C)
A representative can sign instead of you in Items 20A (name), 20B (signature) and 20C (date), but VA accepts that signature only if a VA Form 21-22 or 21-22a naming that representative is on record or included. Casey leaves Section VII blank.
Same office or a different office?
Some guides describe a checkbox for choosing the office that does the review. The March 2024 form has none. The instructions say you may ask for the same or a different office, and VA regulation 38 C.F.R. 3.2601(e) says that, as a general rule, a reviewer in a different office handles the HLR; VA grants a request for the original office unless it has good cause to deny it, such as when only one office processes that type of claim.
Deadline and where to send it
The form must be received within one year of the date on the decision notice. You cannot request an HLR of an HLR decision or a Board decision on the same issue. For disability compensation, VA's HLR page accepts online requests. By mail, send the form to the office for your benefit type; for compensation, VA lists Department of Veterans Affairs, Claims Intake Center, PO Box 4444, Janesville, WI 53547. You can also file in person at a regional office. Keep a copy of the signed form and your confirmation.
If you plan to attach a written statement instead of requesting a conference, Sample 2 in the appeal letter samples is written for a Higher-Level Review. If you have new evidence, the comparison of review options shows which reviews accept it.
Claim Raven sells claim-preparation tools, including the one linked on this page, and has a commercial interest in them.
Sources and scope
Checked September 23, 2026: VA Form 20-0996 (VA's form page lists the March 2024 revision; the PDF supersedes the September 2022 edition) and its printed instructions, VA's Higher-Level Review page, and 38 C.F.R. 3.2601 on eCFR. Casey Rivera and every entry above are fictional.
VA Form 20-0995 Example: Supplemental Claim, Item by Item
Prepare for a VA Higher-Level Review Informal Conference
VA Form 21-526EZ Example: Filling Out the 2026 Form