Higher-Level Review (HLR) Guide

Which Appeal Lane Should You Choose?

After a denial or low rating, you have three options. Choosing the right one is the most important decision you'll make.

How to read these rates: "win rate" for Supplemental Claim and Higher-Level Review means roughly how often the veteran gets a favorable change. The VA does not publish official figures for these lanes; about 50% is the estimate commonly cited by veterans-law firms (Hill & Ponton, CCK Law). The Board figure is the grant rate from RateMyVSO's analysis of 829,000+ published BVA decisions; remands are counted separately, so they are not the same measure. None of these predicts your individual outcome.

What Is a Higher-Level Review?

A Higher-Level Review (HLR) is a request for a more experienced rater (a Decision Review Officer) to look at the same evidence that was already in your file. They review the original decision for errors. Did the rater apply the rating criteria correctly? Did they consider all the evidence? Did they follow VA procedures?

Key Rules

• No new evidence. You cannot submit new documents, nexus letters, or buddy statements with an HLR. The reviewer only looks at what was already in your file.
• No appeal of an appeal. You cannot file an HLR on an HLR decision. If your HLR is denied, your options are a Supplemental Claim or Board appeal.
• Same effective date. If the HLR overturns the denial, your effective date is preserved from the original claim (or Intent to File).
• You can request an informal conference. This is a phone call with the reviewer, highly recommended. See below.
• Duty to Assist errors. If the reviewer finds the VA didn't properly develop your claim (e.g., never ordered a C&P exam), they'll return it for correction.

DRO Outcomes: Two Distinct Actions

When a Decision Review Officer identifies a problem with how a claim was processed, they work through one of two paths. A duty to assist error means the VA was obligated to take a specific action and didn't, such as ordering a required C&P exam, requesting service records, or following prescribed procedures. A difference of opinion means the DRO believes additional development is warranted based on their own read of the evidence, even if the prior rater wasn't technically out of bounds.

In most cases the outcome of an HLR is further development (a new exam, a records request), not an outright grant. Direct grants happen when a favorable, authentic medical opinion is already in the file and the error was that the prior rater didn't apply it correctly. Setting that expectation before filing helps veterans understand what a successful HLR actually looks like.

When HLR Is the Right Choice

File an HLR when you believe the VA made an error of law or fact with the evidence already on file:

• The C&P exam supports your claim but the rater ignored it. Example: the examiner documented 30% symptoms but the rater only awarded 10%.
• The rater applied the wrong diagnostic code or criteria. Your condition was rated under a less favorable code when a more appropriate one exists.
• The VA didn't order a required exam. For certain conditions (including MST claims), the VA is legally required to provide a C&P exam. If they denied without one, that's a duty to assist error.
• Records are missing and the VA didn't follow procedures. If the VA denied your claim without issuing a Formal Finding of Unavailability, searching alternative sources, or advising you of your right to submit substitute evidence, that's a duty to assist error. See Missing Records Guide →
• The rater didn't consider all evidence. Your private medical opinion or buddy statements were in the file but not mentioned in the decision.
• The rater misinterpreted the rating schedule. For example, not accounting for DeLuca factors (pain, flare-ups) in a musculoskeletal rating. See Painful Motion guide →
• Clear and Unmistakable Error (CUE). The original decision contained an obvious error of fact or law that would change the outcome.

When NOT to File an HLR

• You have new evidence to submit. HLR doesn't allow new evidence. File a Supplemental Claim.
• Your C&P exam was unfavorable and you didn't get a private opinion. The reviewer will rely on the same bad exam. Get a private opinion and file Supplemental.
• You disagree with the medical opinion, not the VA's process. HLR reviews process errors, not medical judgment. A new private opinion submitted via Supplemental Claim is the fix.
• You already had an HLR on this decision. You can't HLR an HLR. Your options are Supplemental Claim or Board appeal.

The Informal Conference

When you file the HLR, you can request an informal conference, a phone call between you (or your VSO representative) and the Decision Review Officer. Always request this.

Why It Matters

The informal conference is your only opportunity to communicate directly with the Decision Review Officer reviewing your case. The conversation is two-directional. Veterans and their representatives can ask the DRO questions, not only present information.

Decision Review Officers document their development plans on an internal VA form (VA Form 20-0999) that records what they are ordering and why. This form is not accessible to veterans, but the DRO can be asked during the informal conference what examination or development they intend to order and which theory of service connection they are evaluating (direct, secondary, aggravation, or toxic exposure).

What You Can Discuss

• Specific errors in the original decision: "the rater didn't address my private medical opinion on page X"
• Rating criteria that appear to have been misapplied: "the examiner documented flare-ups but the rater didn't consider DeLuca factors"
• Evidence that was in the file but not mentioned: "my buddy statement describing daily symptoms was not addressed in the decision"
• What exam or development the DRO intends to order, and which theory of service connection is being evaluated

Veterans who know which theory of service connection is being developed before any subsequent C&P exam are better positioned to present history relevant to that theory. Veterans who go into a follow-up exam without this information sometimes present a strong account for the wrong theory, describing symptoms relevant to direct service connection, for example, when the DRO is actually developing a TERA (toxic exposure) pathway.

Who Should Be on the Call?

You can have your VSO representative conduct the informal conference on your behalf. Many veterans prefer this because VSOs know the rating criteria and can speak the VA's language. Find a VSO rep →

The HLR Process: Step by Step

Common Errors Found in HLRs

Based on our analysis of BVA decisions that followed failed HLRs, these are the most common errors that HLR reviewers identify:

• Duty to Assist failure. The VA didn't obtain service records, didn't order a C&P exam, or didn't request relevant medical records. This is the #1 error found.
• Inadequate C&P exam. The examiner didn't test range of motion during flare-ups, didn't address DeLuca factors, or provided an opinion without adequate rationale.
• Ignored favorable evidence. A private medical opinion or buddy statement was in the file but the rater didn't address it in the decision.
• Wrong diagnostic code. The condition was rated under a less favorable code when a more appropriate one exists. See Analogous Ratings →
• Failure to consider secondary service connection. The rater didn't evaluate whether the condition could be secondary to an already service-connected disability.
• Incorrect effective date. The effective date didn't account for an earlier Intent to File or prior claim. See Effective Dates guide →

If Your HLR Is Denied

An HLR denial is not the end. You have two options:

Option 1: Supplemental Claim (Recommended)

Now that you've seen what the senior rater focused on, you know exactly what evidence to get. File a Supplemental Claim with:

• A private medical opinion (nexus letter) that directly addresses the reasons for denial. Nexus Letter Guide →
• New buddy statements addressing specific gaps in your evidence
• Updated medical records showing current severity
• A personal statement addressing the denial reasons. A VSO representative can help you draft one at no charge. Find a VSO Rep →

Option 2: Board of Veterans' Appeals

If you believe the error is legal rather than evidentiary, appeal to the BVA where a Veterans Law Judge will review your case. Our BVA data shows about a 26% grant rate at the Board (grant-only; remands are separate). For some conditions, grant rates are higher among veterans who had a hearing, see the per-condition hearing-vs-no-hearing data and the Board Hearing guide.

• Appeals Overview →
• Board Hearing: What to Expect →, the three hearing formats, how to prepare, and what the day is like.
• Appeal Outcomes by Condition →
• Judge Decision Analytics →
• BVA Decision Search → (read the actual rulings on appeals like yours)

What Happens to Medical Opinions on HLR Return (May 2026 Update)

M21-1, Part IV, Subpart i, 2.A.7.a was updated 2026-05-27. The update adds an HLR-return exception to the normal "complex medical opinion" routing rule.

Under the standard rule, certain opinion types are "complex" and must be prepared by the rating activity (not the development activity). Complex types include:

• Opinions based on military sexual trauma stressors
• 38 USC 1151 compensation
• Aggravation, including Allen aggravation
• Diagnostic variation or conflicting medical evidence
• Credibility-of-evidence questions
• Rare disorders or sensitive / high-priority claims

The new exception: when a BVA remand or HLR return directs development for an aggravation opinion (including Allen aggravation), the development activity may prepare and order the medical opinion based on the remand or HLR instructions, without referring the case back to the rating activity. If the development activity recognizes that a different complex-opinion type is also needed (MST, 1151, conflicting evidence, etc.), it must still refer to the rating activity.

What this means for veterans on HLR remand. If your HLR identified a duty-to-assist error and returned the case for a new aggravation opinion, the development activity can move forward without an extra rating-activity hand-off. That should shave time off the post-HLR development cycle. The substantive standard (Allen v. Brown for aggravation by secondary service-connected disability, the clear-and-unmistakable-evidence rebuttal rule) is unchanged.

Source: M21-1, Part IV, Subpart i, 2.A.7.a (effective 2026-05-27). Read it at KnowVA.