General Information on HLRs

1. General Information on HLRs

Introduction

This topic contains general information on higher-level reviews (HLRs), including

• definition of HLRs
• authority of higher-level reviewers
• restrictions of HLRs
• who may conduct HLRs
• overview of the HLR process
• opting into HLRs from legacy appeals
• defining evidentiary records from HLRs
• controlling issues inextricably intertwined with HLRs
• regulatory authorities for changing decisions, and
• difference of opinion vs. a duty to assist error in HLRs.

Change Date

June 12, 2026

5.1.a. Definition: Higher-Level Reviews

Higher-level reviews (HLRs) consist of de novo reviews of the issue(s) identified by requesters on a completed VA Form 20-0996, Decision Review Request: Higher-Level Review. De novo review means the reviewer reexamines and readjudicates the claim in question without deference to the prior decision, except for proper favorable findings.

References: For more information on

• de novo review, see M21-5, Chapter 7, Section A, 1.e.
• HLRs, see
• 38 CFR 3.2500, and
• 38 CFR 3.2601.

5.1.b. Authority of Higher-Level Reviewers

In addition to de novo review, a higher-level reviewer may also change a decision based upon difference of opinion. The higher-level reviewer may not use difference of opinion to revise the decision in a manner that is less advantageous to the claimant. However, the higher-level reviewer may use clear and unmistakable error (CUE) under 38 CFR 3.105 to reverse or revise, even if disadvantageous to the claimant, any prior VA decision. However, absent a completed VA Form 20-0996 for the issue, the higher-level reviewer does not have jurisdiction over any assertion by a claimant of a CUE.

Any finding favorable to the claimant is binding on subsequent adjudicators, including both higher-level reviewers and other decisionmakers, except when rebutted by clear and unmistakable evidence to the contrary.

Note: Ensure the "difference of opinion" disposition is used in the Veterans Benefits Management System (VBMS) if a higher-level reviewer changes the decision based on difference of opinion.

5.1.c. Restrictions of HLRs

VA must receive the completed VA Form 20-0996 within one year of the date of the notification letter for a decision made on or after February 19, 2019. DROCs should follow the below table when processing HLRs received more than one year after the date of the notification letter:

Scroll sideways to see the full table.

A claimant may not request an HLR of an HLR, or an HLR of a Board decision involving the same issue. VA must make at least one intervening claim decision in such circumstances.

When a Board decision results in granting downstream issues (e.g., evaluation, effective date, or entitlement to ancillary benefits if those claim elements were not specifically addressed in the appeal decision) such as to confer new appeal rights consistent with M21-5 Chapter 7, Section D, 2.h., these downstream issues are eligible for review under any of AMA's three review options. Therefore, a claimant may file an HLR (or Claim Accuracy Request (CAR)), supplemental claim, or Board appeal on a downstream issue decided by VBA resulting from the Board decision.

Example: The Board issues a decision granting service connection for hearing loss. The rating decision effectuates the Board grant and assigns a noncompensable evaluation. In this case, the claimant may file an HLR for the assigned evaluation.

HLRs cannot be requested for proposed decisions.

The HLR evidentiary record is closed as of the date of the decision notice of the issue receiving review, which can include a new or supplemental claim decision. An HLR reviewer cannot consider any evidence that was not of record at the time of the contested decision. However, after a decision to grant a benefit, such as service connection (SC), using a favorable finding, rather than a formal rating decision, the reviewer may return the HLR for additional development of all downstream issues, (e.g., evaluation, effective date, or entitlement to ancillary benefits). Personnel may also implement adverse actions resulting from HLRs.

Note: Late flowing evidence can be considered on an HLR if the evidence is date stamped prior to the notification letter of the decision being reviewed.

References: For more information on

• downstream issues, see M21-5, Chapter 7, Section A, 1.f
• inextricably intertwined issues, see M21-5, Chapter 7, Section A, 1.g
• letters referenced, see the Letter Creator application
• due process notices for proposed adverse actions, see M21-1, Part X, Subpart ii, 3.B.1.a
• late-flowing mail, see M21-1, Part II, Subpart i, 2.A.5.c.
• withdrawing a claim, see M21-1, Part II, Subpart iii, 2.F.
• withdrawing a decision review request and mail intake, see M21-5, Chapter 4
• for PMC legacy appeals and remand procedures, see M21-5, Chapter 7, Section G, 3.e, and
• for PMC decision review request procedures, see M21-5, Chapter 5, Topic 2.a.

5.1.d. Who May Conduct HLRs

Experienced adjudicators who did not participate in the prior decisions will conduct HLRs. Decision Review Officers (DROs) at decision review operations centers (DROCs) have the authority to conduct HLRs for compensation and pension rating issues. Other business lines established their own processing rules and locations.

For non-rating issues at the DROCs, Authorization Veterans Service Representatives (GS-11 or higher) or Authorization Quality Review Specialists (AQRSs) have HLR authority.

HLR requests for specialized contentions such as Spina Bifida, mustard gas, etc. will be routed by the National Work Queue (NWQ) to the stations responsible for processing such claims. The Office of Administrative Review (OAR) or the Office of Field Operations (OFO) may occasionally authorize deviations to these routing procedures. Absent operational guidance regarding jurisdiction of specialized issue cases, DROCs should follow the below table:

Scroll sideways to see the full table.

If DROs, Authorization VSRs, or AQRSs are unavailable at specialized processing centers, local management may appoint higher-level reviewers with authority over the issue and who are otherwise qualified to conduct informal conferences. See M21-5, Chapter 5, Topic 3.b.

5.1.e. Overview of the HLR Process

The following table is an overview of the process used by the higher-level reviewer:

Scroll sideways to see the full table.

When appropriate, multiple HLRs will be grouped and routed to users to process concurrently. If pending HLRs were not appropriately grouped, follow local procedures to request and assign the HLR to the VBMS queue of the requesting DROC. Questions regarding the jurisdiction for multiple HLRs may be sent to Office of Administrative Review (OAR) Operations at OAROPS.VBAWAS@va.gov.

Reference: For more information on grouped EPs and requesting assignment, please see the VBMS User Guide.

5.1.f. Opting Into HLRs From Legacy Appeals

Public Law 115-55, the Veterans Appeals Improvement and Modernization Act of 2017 (Appeals Modernization Act (AMA)), authorized VA to conduct HLRs. VA implemented AMA on February 19, 2019.

However, legacy appellants may still withdraw appeals to the Board and opt for HLRs or supplemental claim reviews under AMA for 60 days after receiving a Statement of the Case (SOC) or Supplemental Statement of the Case (SSOC). The mere fact of having a pending legacy appeal is insufficient to opt into an HLR or supplemental claim; VA must have sent an SOC/SSOC on or after February 19, 2019, for the claimant to be eligible to opt in to AMA.

5.1.g. Defining Evidentiary Records for HLRs

A claimant can use a single VA Form 20-0996, Decision Review Request: Higher-Level Review, to request review of issues from decisions that occurred on separate dates, as long as VA receives the form within one year of notification of the decisions containing the issues listed for review.

When this occurs, the higher-level reviewer must ensure that the claimant is properly notified of the evidentiary record associated with the HLR decision because HLRs are, by definition, based on the same evidentiary record of the former decisions. See 38 CFR 3.2601(f). Therefore, the HLR decision, when it stems from earlier decisions of different dates, must indicate which evidence pertains to which decisions.

Document the different evidentiary records by adding the following statement to the HLR decision Introduction section in VBMS-Rating (VBMS-R):

"Please note: In a higher-level review, only evidence in your file when VA made the earlier decision can be considered. The reviewer cannot look at any new evidence; therefore, VA will only consider evidence received by VA prior to or on [date] for [conditions]. Further, VA will only consider evidence received by VA prior to or on [date] for [conditions]."

Note: Clearly identify each evidentiary record for each issue only when the conditions under review stem from different decision dates. This requirement is not needed if all decisions under review arise from the same decision date.

5.1.h. Controlling Issues Inextricably Intertwined with HLRs

The term inextricably intertwined relates to a situation when a decision on a pending primary issue would have a direct and significant impact on a decision of a pending derivative (or intertwined) issue of the same benefit type (e.g., compensation, pension, etc.)

Generally, an inextricably intertwined issue should be processed with the primary issue. However, in some situations, the office with jurisdiction of the primary issue will not have jurisdiction of the pending intertwined issue.

For example: a claimant has a pending HLR on the issue of service connection for lumbosacral strain, and subsequently files an initial or supplemental claim for service connection for bilateral knee strain, secondary to the claimed lumbosacral strain. In this example, consider secondary service connection for bilateral knee strain to be intertwined with the primary issue of service connection for lumbosacral strain.

If an HLR is either the primary or intertwined issue (even when intertwined with an issue at the Board), continue processing the HLR normally. The HLR is decided based on a closed record; therefore, any forthcoming decisions cannot be considered as part of the record for this HLR.

Example: A veteran files an HLR for denial of service connection for left leg neuropathy secondary to a back condition. Service connection for the back condition is currently pending with the Board. The evidence of record does not support granting service connection for the left leg neuropathy under any other theory of entitlement (presumptive, direct, etc.). Process the HLR under normal procedures, rendering a decision on the claimed left leg neuropathy, despite the intertwined issue pending with the Board.

If the Veteran claims individual unemployability (TDIU), and it is intertwined with another condition on appeal, render a decision on TDIU even though intertwined issues are pending with the Board. The Board may then infer TDIU as an issue in connection with the pending appeal.

References: for more information on:

• inextricably intertwined issues, see M21-5, Chapter 7, Section A, 1.g
• individual unemployability, see M21-1, Part VIII, Subpart iv, 3.C and 38 CFR 4.16.

5.1.i. Regulatory Authorities for Changing Decisions

Higher level reviewers have multiple authorities for making new decisions, which include

• difference of opinion (DoO), and
• clear and unmistakable error (CUE).

Difference of opinion involves the de novo re-examination of a prior decision and its associated evidence. It allows re-weighing of that prior evidence, so the decision maker may make a new decision without regard to the earlier one. The reviewer cannot use DoO to revise the prior decision in a manner that would be less advantageous to the claimant. However, the reviewer may use CUE to adversely revise a decision when necessary.

To minimize overpayments, underpayments, and inaccurately continuing beneficiaries for benefits, DROCMs or designees must log each CUE decision in the Compensation Service CUE Microsoft SharePoint site. See M21-1, Part X, Subpart ii, 5.A.3.f.

Reference: For more information on

• the authorities for making new decisions on HLRs, see 38 CFR 3.2601(i) and (j),
• CUE, see M21-1, Part X, Subpart ii, 5.A, and
• DoO, see 38 CFR 3.105(b).

5.1.j. Difference of Opinion vs. Duty to Assist Error

A true error in VA's duty to assist (DTA) contains two components: VA's obligation under 38 CFR 3.159 to assist in obtaining certain evidence and VA's failure to do so at the time of the prior decision.

The exercise of a difference of opinion may lead to additional development, but that development does not necessarily mean that the prior decision failed to properly assist the claimant. The HLR reviewer has the authority to weigh the same evidence differently than the earlier adjudicator and may change the previous decision based on difference of opinion. If the difference of opinion results in the need for an examination or further development, then the reviewer must document this on the VA Form 20-0999, Higher Level Review Return. The reviewer must return the case for additional development resulting from a DoO using that same VA Form 20-0999, documenting all relevant details (including manual references), the most appropriate reason for the return, and relevant e-folder document bookmarks in accordance with M21-5, Chapter 5, Topic 5, d. However, this return does not constitute a DTA error as the previous decision was not necessarily incorrect. Rather, the amended decision mandates additional development to resolve, as is often the case, certain downstream issues.

Example: The HLR is requesting service connection (SC) for a condition. The reviewer, weighing the evidence differently than the earlier decision maker, now decides to order an examination based on the evidence of record. The reviewer will document the need for further development (a request for examination based on the review) under DoO, document the favorable findings as necessary, and then return the request for development so VA may order the examination. When VA obtains that examination, the RVSR will formally decide if a grant is warranted based on the examination. If so, the RVSR will assign the evaluation and effective date.

Rationale: The prior decisionmaker was not obligated to order an examination, as it was not necessary to decide the claim. Hence, the prior decision contained no DTA error. However, once the reviewer decided to grant SC based on DoO, VA was required to seek additional development to fairly decide the downstream issues.

Reference: For more information on DTA errors, see M21-5, Chapter 5, Topic 5.a.