M21-5 Chapter 5 reference

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Read the plain-English explanation · HLR development returns

Selected M21-5 Chapter 5 authorities for development returns, their controls and notification. This is not a full translation of HLR eligibility, informal conferences, all quality labels or the whole chapter.

M21-5 5.1.b · Preserve the reviewer’s authority and favorable findings

A higher-level reviewer can weigh the existing record differently, but difference of opinion cannot make the decision less favorable. A proper CUE action uses its separate authority. Development staff preserve binding favorable findings and do not substitute their own decision.

M21-5 5.1.c · The HLR and its later return have different records

While the HLR is pending, the evidentiary record closes at the prior decision notice. A return for downstream development follows the actual favorable findings and instructions. Do not mistake that return for an instruction to keep excluding new development evidence. Direct HLR of an HLR or Board decision is restricted; a new VBA downstream decision has its own review options.

M21-5 5.1.e · A return ends the HLR for that issue

The reviewer decides unaffected issues where appropriate. If a DTA error or difference of opinion requires development and the maximum benefit cannot be granted, the affected issue is returned for development and a new decision. Keep the disposition of each issue separate.

M21-5 5.1.i · Difference of opinion and CUE are distinct authorities

A difference of opinion reweighs the same earlier evidence and cannot make the result less advantageous. Adverse revision for CUE requires the proper CUE authority and safeguards. Do not infer either finding from the EP number.

M21-5 5.1.j · Extra development does not automatically mean VA made an error

A true DTA error means VA had a duty to obtain particular evidence and failed before the earlier decision. A reviewer’s different weighing of that record may instead create a need for an examination or downstream development. Both use the documented 20-0999 return; preserve the correct difference-of-opinion or DTA disposition, explanation, references and bookmarks.

M21-5 5.4.a · New evidence cannot be added to a still-pending HLR record

For the HLR decision itself, explain that evidence received after the record closed could not be considered. Use the source’s prescribed notice. This restriction does not turn the subsequent authorized development return into another closed-record HLR.

M21-5 5.4.c · Mark previously unconsidered evidence accurately

Upload and identify retained evidence using the prescribed Evidence not considered in HLR of [date] subject. A later decisionmaker who considers it updates the subject to Evidence considered in decision of [date]. Keep the actual dates and record boundaries.

M21-5 5.5.a · Correct the missed assistance unless the maximum benefit can be granted

Missing required development or examinations can require an HLR return. Apply the return process also to downstream development for a grant reflected in favorable findings but not fully implemented. The authorized reviewer makes the decision; development carries out the instructions.

M21-5 5.5.b · A service-connection finding may leave downstream work

Maximum benefit means the highest schedular evaluation for the issue; for an ancillary benefit it means the benefit sought. Evaluation is downstream of service connection. A favorable service-connection finding does not necessarily mean the entire benefit can already be implemented.

M21-5 5.5.c · Missing VA records require the actual notice and record facts

The reviewer checks whether sufficiently identified VA treatment records were missing and unconsidered before the challenged decision notice. A record merely existing somewhere in a VA system is not enough to establish constructive notice. Develop the identified missing records under the actual return; do not independently declare an error from a later discovery alone.

M21-5 5.5.d · Use the complete 20-0999

The return identifies each affected issue, missed assistance or directed development, pertinent manual authority and document bookmarks. Include favorable findings needed for downstream or reasonably raised secondary development. The return ends the HLR for that issue; VSRs/RVSRs then process its development. The quoted Your Benefit Information notice in this paragraph applies when at least one issue is decided.

M21-5 5.5.e · Verify control, date and both notification stages

The reviewer handles issues that can be decided and completes the 20-0999 for those needing development. A VSR promulgates the EP 030. For a full DTA return, send the rating and prescribed initial notice and use both listed appeal-rights suppression settings. This is not suppression of rights for a later merits decision.

After authorization, verify the automatically created EP 040 and correct rating/non-rating return label. Its DOC is the actual EP 030 closure date, not the original claim or a guessed effective date. HLR returns, including differences of opinion, route through NWQ to VSCs for development and the later decision.

For a DTA return, send the HLR DTA letter when the development will not generate another development letter. Otherwise add the source’s prescribed explanation and the actions VA will take to the development letter. A difference-of-opinion return must not be inaccurately described as a prior DTA error; confirm appropriate authorized wording for that disposition.

M21-5 5.5.f · Expedite the correction

Development, authorization and rating staff must expedite HLR DTA corrections. Expedited handling does not eliminate the required evidence, follow-up, claimant response or notice steps.

M21-5 5.5.g · Every contention needs the correct disposition

Keep examination/opinion, Federal records, other records, PMR and difference-of-opinion dispositions distinct. At award review, compare the codesheet/supplemental decision with the disposition generated in VBMS-Awards. Return a mismatch for correction; do not silently change the meaning or leave a contention without a disposition.

M21-5 5.6.a · Use the authorized non-rating decision process

Non-rating HLR decisions are generated in VBMS-Awards under the current chapter; rating decisions use VBMS-R. The returned issue’s actual benefit and authority determine its next decision activity, not the EP number alone.

M21-5 5.6.b · Include the non-rating decision with its notice

The completed NR AMA Decision is uploaded to VBMS and a copy is enclosed with the decision letter. The explanation and review rights must match the actual decision.

M21-5 5.7.b · A quality-correction return has a different predecessor date

An EP 930 correcting an HLR can identify a DTA error and return affected contentions for development. VBMS automatically establishes the resulting EP 040, whose DOC is the date that EP 930 cleared. Verify the actual quality label, predecessor and date instead of always assuming EP 030.

Checked 2026-09-08. Read the captured original →

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Overview

In This Chapter

This chapter contains the following topics:

Topic	Topic Name
1	General Information on HLRs
2	Initial Actions Upon Requests for HLRs
3	Requests for Informal Conferences
4	Attempts to Introduce New Evidence
5	Errors in the Duty to Assist
6	Non-Rating Issues
7	Tracking HLRs

1. General Information on HLRs

Introduction

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

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:

If...	Then...
The HLR contains issue(s) that are all not timely received	Establish an end product (EP) 400 - Correspondence with the date of receipt, inform the claimant using the HLR Not Timely letter, and clear the EP 400.
The HLR contains issue(s) that are all not timely received and is erroneously established as an EP 030	Cancel the EP 030, establish an EP 400 - Correspondence with the date of receipt, inform the claimant using the HLR Not Timely letter, and clear the EP 400.
The HLR contains multiple issues, some timely, and some not timely, received	Establish the EP 030 for the timely received issues with the date of receipt, and process accordingly, and establish an EP 400 - Correspondence with the date of receipt, inform the claimant of the untimely issues using the HLR Not Timely letter, and clear the EP 400.

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:

If...

Then...

The HLR involves an issue that is typically specialized under M21-1 Part II, Subpart ii, 3.1.b

NWQ will generally route the claim to the station listed in that reference

Note: See M21-5, Chapter 1, Section A, 3.f for a list of specialized issues for which the DROC has jurisdiction.

The HLR does not involve a specialized issue listed in M21-1, Part II, Subpart ii, 3.1.b

NWQ will generally route the claim to a DROC

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:

Stage

Description

Confirm that the HLR application is complete and each issue is eligible for an HLR. See M21-5, Chapter 5, Topic 2.a.

Verify if there are other HLRs of the same type (rating or non-rating) for the Veteran/claimant. If so, and the HLR EPs are not already assigned to the higher-level reviewer's VBMS queue, coordinate to have the appropriate EPs assigned. Address all HLRs of the same type under a single decision wherever practicable, ensuring that rating issues are addressed separately from non-rating issues. However, if there is a distinct representative for each HLR, then a separate decision must be rendered for each HLR.

Identify whether the applicant requested an informal conference. If so, attempt to schedule it. See M21-5, Chapter 5, Topic 3.b and M21-5, Chapter 5, Topic 3.h.

Review the prior decision(s) de novo, using only the evidence of record as of the notification date of the prior decision(s) under review.

Determine if VA erred in its duty to assist while processing the prior decision(s), or if the HLR reviewer finds a Difference of Opinion when weighing the same body of evidence.

If...	Then...
VA erred in its duty to assist or found a Difference of Opinion and cannot grant the maximum benefit	Return the case for development and a new decision - see M21-5, Chapter 5, Topic 5.a. The HLR for that issue is complete.
VA did not err in its duty to assist nor find a Difference of Opinion	Continue to stage 6.

Determine if evidence was submitted after the prior decision notice and, if so, inform the claimant that VA cannot consider it. See M21-5, Chapter 5, Topic 4.a.

Issue a decision. The HLR is complete.

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.

2. Initial Actions Upon Requests for HLRs

Introduction

This topic contains information on initial actions to take upon receiving a request for an HLR, including

Change Date

June 12, 2026

5.2.a. Definition of a Complete Request for an HLR

A complete request for an HLR includes the following:

name of the claimant and the relationship to the Veteran, if applicable
signature of the claimant, or a person legally authorized to sign for the claimant
date of the underlying decision for which review is requested, and
specific issues for which review is requested.

Important: When the actual date of the decision of which the claimant requested review, and the date listed on the VA Form 20-0996, Decision Review Request: Higher Level Review, do not match, VA should accept the HLR if VA can reasonably ascertain the issue involved and if VA timely received the HLR request. Further, the absence of the notification date on the HLR does not necessarily preclude the acceptance of the HLR request. If blank, claims processors should contact the Veteran and/or applicable representative for clarification of the date and document contact on VA Form 27-0820, Report of General Information.

For incomplete requests, follow the procedures in M21-5, Chapter 4, Topic 2.e.

Handle requests for HLR using a form not prescribed by VA as a request for the application. See M21-1, Part II, Subpart iii, 1.A.1.a.

Reference: For more information on

completed requests, see 38 CFR 3.2601, and
timeliness of review requests, see M21-5, Chapter 5, Topic 1.c.

5.2.b. Initial Actions to Take With an HLR Request

When a claimant requests an HLR after receiving a notification letter of a decision, follow the steps noted below.

Step	Action
1	Review the claimant's electronic claims folder (eFolder) to determine what issues VA previously decided. If any issue identified on the form is not eligible for HLR, send the claimant and any representative an HLR Rejection letter for that issue and upload the letter into the eFolder.
2	Check if the claimant or representative requested an informal conference.
3	The NWQ will refer the end product (EP) 030 to a higher-level reviewer for continued processing.
4	The higher-level reviewer will validate and classify the dispositions of the contentions in VBMS.

5.2.c. Handling Requests to Conduct HLRs at Specific Offices

Generally, a different office than that of original jurisdiction will conduct the HLR. Requesters may ask that the same office that prepared the decision in question also conduct the HLR. VA may experience difficulty accommodating such requests unless the office of original jurisdiction is co-located at the office conducting the HLR, such as the DROCs in Seattle and St. Petersburg. However, exceptions to this rule may also apply for claims requiring specialized processing.

When unable to accommodate the claimant’s request regarding venue for the HLR, insert the following paragraph in the introduction of the decision document:

You requested to have your higher-level review conducted at the same office that decided your claim. Unfortunately, we were unable to fulfill your request because that office does not have personnel available to conduct higher-level reviews (see 38 CFR 3.2601(e)). Accordingly, we conducted your review at an office with the appropriate personnel available.

References: For more information on where VA may conduct HLRs, see 38 CFR 3.2601.

5.2.d. Actions to Take if an HLR is Erroneously Established

If a higher-level reviewer identifies an erroneously established EP 030, the reviewer should:

If...

Then...

An HLR EP 030 is erroneously established and NO action is required

Add a VBMS claim note explaining why the EP 030 should be cancelled and identify that no corrective action is needed.

Cancel the EP 030 in SHARE and,

E-mail supervisor to advise that the higher-level reviewer cancelled the EP 030, completed a VBMS note providing cancellation details and advise that no further action is necessary.

An HLR EP 030 is erroneously established, and action IS required

Add VBMS claim note explaining why the EP 030 should be cancelled and identify in the note any necessary corrective action, such as sending out a letter.

E-mail supervisor to advise that the higher-level reviewer documented the necessary action to take in a VBMS claim note.

The supervisor will then assign that necessary action to a claims processor on the pending EP 030.

5.2.e. Addressing IU in an HLR

Follow the steps in the table below to determine whether IU should be addressed in an HLR when expressly claimed or reasonably raised within the closed evidentiary record.

If...

Then...

IU has been expressly claimed, or reasonably raised, and that documentation and/or evidence falls within the scope of the closed record review

Consider IU as a contention within the HLR and render a decision accordingly

If...	Then...
IU cannot be properly decided based on the closed evidentiary record	Return the issue as a DTA error for development and adjudication

IU has been expressly claimed, or reasonably raised, but that documentation and/or evidence does not fall within the closed record review

IU cannot be considered as part of the HLR because it falls outside the scope of the closed record review.

If the underlying condition(s) are all outside the scope of the HLR, IU must be developed and decided under a separate EP in VBMS.

If all of the underlying conditions are within the scope of the HLR,

Advise of the prohibition of considering new evidence outside the closed evidentiary record

If there are multiple underlying conditions with some, but not all, falling within the scope of the HLR,

Advise of the prohibition of considering new evidence outside the closed evidentiary record.
The issues outside the scope of the HLR should be adjudicated in accordance with M21-1, Part VIII, Subpart iv, 3.B.

References: For information on

the role of VA Form 21-8940 in development of IU claims, see M21-1, Part VIII, Subpart iv, 3.B.1.b, and
reasonably raised claims for IU, see M21-1, Part VIII, Subpart iv, 3.B.1.f

5.2.f. Addressing unadjudicated ancillary benefits in an HLR

A claimant may contest a VA decision for failure to grant an ancillary benefit. The decisionmaker should consider these issues as within the scope of an expressly claimed issue in the rating decision identified on the VA Form 20-0996.

Some of these ancillary benefits include, but are not limited to:

Dependents' Educational Assistance, or Chapter 35
SMC(s) based on statutory housebound under 38 CFR 3.350(i)(1)
SMC(k) based on loss of use or anatomical loss under 38 CFR 3.350(a)

Follow the steps in the table below to determine whether an unadjudicated ancillary benefit should be addressed when the VA Form 20-0996 lists failure to grant a benefit as an issue:

If...

Then...

The benefit can be granted under the HLR

Grant the benefit in the HLR decision.

The benefit cannot be granted, but a DTA error or Difference of Opinion is discovered during the HLR review

Formally address the benefit in the HLR decision by citing a DTA error or Difference of Opinion and provide instructions for corrective action on the VA Form 20-0999.

The benefit cannot be granted based on the closed evidentiary record

Deny entitlement to the ancillary benefit.

Note: If the claimant is not eligible for the ancillary benefit because the underlying disability is not service-connected, also send an RFA letter.

References: For information on

Issues within the scope of the claim, see 38 CFR 3.155(d)(2)
Definition of an ancillary benefit, see M21-1, Part V, Subpart ii, 3.A.1.e
Defining ancillary benefits as within the scope of a claim, see M21-1, Part V, Subpart ii, 3.A.1.c.

5.2.g. HLRs and Changes to the Rating Schedule

Use the table below when adjudicating an issue under HLR that was last decided prior to a change in the VA Schedule for Rating Disabilities, where the change is relevant to the disability evaluation of the issue under review.

If...

Then...

The evidence of record is sufficient to assign an evaluation both before and after the date of the regulatory change, based on all applicable criteria

Render the HLR decision using the previous criteria for the period before the regulatory change and the new criteria for the period after the regulatory change (see M21-1, Part V, Subpart ii, 3.D.2.h).

The evidence of record is not sufficient to properly assign an evaluation after the date of the regulatory change

A change in the rating schedule is not a duty to assist error. Assuming all other aspects of development and VA's duty to assist were met, return the claim using Difference of Opinion (DoO) as the rationale.

Development (such as exams) will then be completed under the DoO return and a final decision issued following guidance in M21-1, Part V, Subpart ii, 3.D.

References: For information on

Difference of Opinion in HLRs, see 38 CFR 3.2601(j)
Change of law or Department of Veterans Affairs issue, see 38 CFR 3.114 and 38 U.S.C. 5110(g).

5.2.h. HLRs and Changes to Law, Regulation or Judicial Precedent

HLR decisionmakers must consider changes to law, regulation or judicial precedent even if it occurs after the decision under review. The closed evidentiary record principle does not apply to changes in law, regulation or judicial precedent.

Use the table below when adjudicating an issue under HLR that was last decided before a change in law, regulation or judicial precedent.

If the issue is...	Then...
not affected by a change	generate a decision to grant, deny, or return the issue based on the evidence available at the time of the previous decision.
affected by a change, but the maximum benefit can be granted for service connection or for an evaluation from the earliest effective date	render a decision on the issue granting entitlement.
affected by a change and involves: service connection that can be granted, but not at the maximum benefit; or service connection that cannot be granted; or an increased evaluation that can be granted but not at the maximum benefit; or an increased evaluation that cannot be granted; or an effective date for service connection or evaluation where an earlier date may be warranted, and all required development related to the change was not previously undertaken or is otherwise incorrect	return the issue for development as a DTA error.
affected by a change, but all required development, including development related to the change, was previously and sufficiently completed	generate a decision to grant, deny, or return the issue based on the evidence available at the time of the previous decision.

Note: The guidance to return as a DTA error applies even if the prior decisionmaker acted in accordance with the guidance in effect at the time of the decision.

Example 1: A Veteran with verified military service in Somalia in October 1993 has confirmed active bladder cancer. Rating decision dated December 10, 2024, denied service connection following sufficient development and examination based on a negative TERA medical opinion. VA amended 38 C.F.R. § 3.320a on January 2, 2025, adding bladder cancer as a presumptive condition for Somalia service after 1990. The Veteran filed an HLR on March 9, 2025. The higher-level reviewer will grant service connection effective January 2, 2025, the date of the regulation change.

Example 2: Rating decision dated June 12, 2025, continued the 10 percent disability evaluation for lumbosacral strain based on an April 2, 2025, examination. The Veteran filed an HLR on December 2, 2025. The April 2, 2025, examination did not address the effect of the Veteran’s medication as required by the September 19, 2025, decision in Ingram v. Collins. The higher-level reviewer will return the issue as a DTA error for the missing information in the VA examination.

References: For information on

Evidentiary record, see M21-5, Chapter 5, Topic 1, Block g.
Definition of maximum benefit, see M21-5, 5.5.b.
Maximizing benefits with effective date determinations, see M21-1, V.ii.4.A.1.i.
Change of law or Department of Veterans Affairs issue, see 38 CFR 3.114 and 38 U.S.C. 5110(g).

5.2.i CUEs Discovered During an HLR

If a CUE is discovered during an HLR, VA is obligated to address the CUE.

Use the table below when addressing a CUE found during an HLR.

If the CUE is discovered during an HLR and the issue is…	Then…
part and parcel of the HLR (e.g., the issue is one claimed by the Veteran, the issue is inextricably intertwined, etc.)	the CUE should be addressed under the existing EP 030.
not part and parcel of the HLR (e.g., the issue is not one claimed by the Veteran, the issue is not inextricably intertwined, etc.), but can be addressed in full without any further development (e.g., assign an earlier effective date, propose to reduce with subsequent due process under an EP 600, etc.)	the CUE should be addressed under the existing EP 030. The following paragraph must be added to the rating decision narrative and notification letter unless the higher-level reviewer proposes adverse action: A clear and unmistakable error has been found related to a previous VA decision on [insert contention]. Because this issue is not part and parcel of your higher-level review, any of the three decision review options are available to you if you disagree with our decision on this issue. Please refer to the enclosed VA Form 20-0998 for more information. If the higher-level reviewer proposes adverse action because of the CUE, then follow procedural guidance contained within M21-1.
not part and parcel of the HLR (e.g., the issue is not one claimed by the Veteran, the issue is not inextricably intertwined, etc.), and cannot be adequately addressed without further development. Example: The Veteran is denied service connection for diabetes mellitus, type II because there is no evidence of agent orange exposure. No exam was requested and the evidence of record only notes a diagnosis, without any additional information. Four years later, during an HLR for an unrelated condition, the DRO identifies Vietnam service is in fact shown in the personnel record. This manifestly changes the outcome of the diabetes mellitus, type II claim (service connection should have been granted as a presumptive), yet the evidence of record is insufficient to adequately assign an evaluation.	an EP 930 is required. Establish an EP 930 with a date of claim corresponding with the claim in question (see M21-4, Appendix B, Topic 2). The EP 930 claim label should be RATING CONTROL or NON-RATING CONTROL, as appropriate. Add a detailed VBMS claim-level note explaining why the EP 930 was established and what steps are required to resolve the claim.

Note: The evidence of record at the time of the CUE in a prior decision is part of the record and subject to review.

References: For Information on

Applicability of due process, see M21-1, Part X, subpart ii.3.
CUE, see M21-1, Part X, subpart ii, 5. A.
Due process and authorization issues for CUE, see M21-1, Part X, subpart ii.5.C.

3. Requests for Informal Conferences

Introduction

This topic contains information on handling requests for informal conferences, including

Change Date

June 12, 2026

5.3.a. Definition of Informal Conferences

An informal conference is contact, typically by telephone, but also using other means that VA determines appropriate, for the sole purpose of allowing a claimant and/or representative the opportunity to identify any errors of law or fact in the prior decision.

5.3.b. Overview of Informal Conferences

When requested by the claimant or representative, VA will conduct one informal conference during a higher-level review, unless both rating and non-rating issues are present. The presence of the claimant is not required if the authorized representative can attend instead.

At the local option, the higher-level reviewer or the Informal Conference Coordinator will arrange the conference, while the reviewer with decision authority over the issue will actually conduct it. VA will not accept any new evidence to support the issue(s) under review during the informal conference. See M21-5, Chapter 5, Topic 4.b.

While VA will typically conduct informal conferences telephonically or by other virtual means, VA may make an exception on an individual basis. VA may conduct the informal conference in person when good cause is shown as to why virtual communication cannot or should not occur.

If there are multiple HLRs with informal conferences requested for rating issues, attempt to schedule one informal conference to address all associated issues. The same guidance applies for multiple HLRs with informal conferences for non-rating issues. As a reminder, if there is a distinct representative for each HLR, then separate decisions are required for each HLR based on representation. In this instance, the multiple HLRs cannot be addressed under a single decision.

Note: Decisionmakers must use VA-approved software (for example, Microsoft Teams) or VA-approved equipment (such as a government-issued phone or personal cellular phone that is authorized for business use under applicable policies).

5.3.c. Initial Actions

The claimant or representative typically requests an informal conference on the HLR form, although VA will accept a separate request provided VA receives it with that form. VA cannot honor requests for informal conferences received on a later date than the requests for HLRs. VA regulations state that "a claimant or his or her representative may include a request for an informal conference with a request for higher level review." See 38 CFR 3.2601(h).

Veterans and/or representatives, who provide VA with an email address on file, may receive a self-scheduling link through the Visitor Engagement Reporting Application (VERA) or other scheduling applications, providing an additional opportunity to select a convenient date and time for the informal conference. Before taking any action, first verify whether an informal conference is already scheduled. If the Veteran or representative does not schedule using VERA, proceed with the procedures in this chapter to schedule by telephone and refer to VA Form 20-0996 to determine who should be contacted to schedule the informal conference.

The reviewer or Informal Conference Coordinator will make a total of two attempts to contact the claimant or representative to schedule. The reviewer will strive to hold the informal conference within fourteen calendar days of successful contact. Please note that the number of attempts made to contact, as well as the time line for scheduling/conducting informal conferences are guidelines, not rigid requirements. Additional efforts or longer time frames may be justified on a case-by-case basis. The key point is to make reasonable efforts to hold or otherwise promptly resolve conferences.

Upon establishment of the EP, employees must add an Informal Conference special issue to at least one of the pending contentions if the claimant has requested an informal conference. The Informal Conference special issue will remain on the contention through completion of the HLR.

Note: Assume the claimant does not desire an informal conference if all sections of item 16, including 16A and 16B, on the VA Form 20-0996 are blank. Request clarification if any information is ambiguous.

5.3.d. Contacting Requesters of Informal Conferences

Veterans and/or representatives may receive a self-scheduling link through VERA before staff initiate telephone contact to schedule an informal conference.

When attempting to schedule an informal conference by telephone, follow the steps in the table below.

If...	Then...
Block 16B of the VA Form 20-0996 indicates that VBA should contact the Veteran/claimant to schedule the informal conference	Contact the claimant to schedule the informal conference
Block 16B of the VA Form 20-0996 indicates that VBA should contact the representative to schedule the informal conference	Contact the representative, not the claimant, to schedule the informal conference
Block 17 of the VA Form 20-0996 lists a representative and includes contact information and block 16B indicates the representative should be contacted	Contact the listed representative, not the claimant, to schedule the informal conference
Block 17 of the VA Form 20-0996 does not list a representative	Contact the claimant to schedule the informal conference
Block 17 of the VA Form 20-0996 lists the claimant's name and contact information, even though there is an accredited representative on file	Contact the claimant to schedule the informal conference
Block 17 of the VA Form 20-0996 lists only a generic representative (for example, a Veterans Service Organization, but without a specific individual's contact information)	Contact the claimant to schedule the informal conference

Important: Before contacting any authorized representative or POA, ensure VA Form 21-22, Appointment of Veterans Service Organization as Claimant's Representative, or VA Form 21-22a, Appointment of Individual as Claimant's Representative, is of record for that POA.

If necessary, validate the accreditation status of the representative by locating the POA within the Office of General Counsel accreditation database at https://www.va.gov/ogc/apps/accreditation/index.asp. Do not contact an unaccredited POA. Instead, call the claimant at the number of record to schedule the informal conference.

If a new or different authorized representative or POA is appropriately appointed after the HLR was received but before the informal conference, contact the claimant or new representative to schedule the informal conference. Do not cancel the pending EP 030 due to a change in representation.

Note: Coordination and scheduling of an informal conference via email is permissible only if all parties involved in coordination efforts assume responsibility for proper safeguarding of personally identifiable information. Any email correspondence must be uploaded to the Veteran's claims file in VBMS. Email should not be used in lieu of telephonic contact, but may be used in conjunction with telephonic contact when scheduling the informal conference.

Reference: For more information on encrypted emails, please refer to the Talent Management System (TMS) course titled VA Privacy and Information Security Awareness and Rules of Behavior (10176).

5.3.e. Unsuccessful Initial Attempts to Contact the Requesters

If the reviewer or Informal Conference Coordinator cannot contact the claimant or representative on the first attempt, VA will

if possible, leave a general voicemail message requesting a return call with a VA contact phone number
Follow Step 4, Initial Attempt to Schedule the IC - Unsuccessful in the table found in M21-5, Chapter 5, Topic 3.h to update the appropriate tracked item, ensuring that both scheduling attempts are made by continuing to follow the steps outlined in the table
document the unsuccessful contact on VA Form 27-0820, Report of General Information
add a permanent note in VBMS with the reason for the call and, depending on local scheduling protocols, request the Informal Conference Coordinator document the requester’s or representative’s availability if either person calls back (see sample text below), and
Wait three business days for the second attempt.

For the permanent note in the VBMS, indicate whether a voicemail was left, using the following suggested text:

I called the requester [or the representative] regarding an informal conference for the pending higher-level review. When he [or she] returns my call, please complete a VA Form 27-0820 to capture a telephone number and a date and time over the next week when the requester or representative will be available during regular business hours for the informal conference.

The reviewer or Informal Conference Coordinator will routinely follow up in VBMS for the status of any replies.

Note: For scheduling purposes, the first business day is counted as the day after the initial contact, and the second attempt can be made on the third business day if no response is received before that time. Weekends and holidays are excluded from this count.

Examples:

If the first attempt is made on Monday, the first business day is Tuesday, the second business day is Wednesday, and the third business day is Thursday (excluding any holidays). If no response is received before Thursday, the second attempt can be made on Thursday.
If the first attempt is made on Wednesday, the first business day is Thursday, the second business day is Friday, and the third business day is Monday (excluding any holidays). If no response is received before Monday, the second attempt can be made on Monday.

Reference: For more information on necessary system updates for scheduling informal conferences, see M21-5, Chapter 5, Topic 3.h.

5.3.f. Unsuccessful Second Attempts to Contact the Requesters

If VA receives no response by the third business day, make a second and last attempt to schedule the informal conference. If the second attempt fails, the reviewer or Informal Conference Coordinator will

document the unsuccessful contact on VA Form 27-0820
follow Step 7, Second Attempt to Schedule the IC - Unsuccessful in the scheduling table found in M21-5, Chapter 5, Topic 3.h to update the appropriate tracked item, ensuring that the scheduling attempts are completed, and continue to follow the steps outlined in the table
add a permanent note of the unsuccessful attempt in VBMS
if applicable, provide a copy of VA Form 27-0820 to the requester's accredited representative and associate it with the eFolder, and
the higher-level reviewer with authority over the issues can then render a final decision on the HLR.

Reference: For more information on necessary system updates for scheduling informal conferences, see M21-5, Chapter 5, Topic 3.h.

5.3.g. Actions to Take After Successful Contact

If contact is made with the requester,

schedule and/or conduct the informal conference, preferably within 14 calendar days of initial contact with the Veteran and/or representative - whenever possible, the decision maker may conduct the conference when successful contact is first made, but only if the claimant or representative (whichever is identified on the VA Form 20-0996 for contact) feels comfortable to hold the conference at that time; the decision maker must advise that the informal conference may be scheduled for a later date
update the designated scheduling system for the scheduled informal conference
follow either step 3 or step 6 of the table in M21-5, Chapter 5, Topic 3.h, depending on which attempt resulted in the informal being successfully scheduled
prior to the informal conference, the decision maker should conduct a review of the contested decision to ensure familiarity with all issues and the applicable evidentiary record
follow the instructions on the HLR Informal Conference Worksheet by reading to the claimant or representative the script on the purpose of the conference
complete an HLR Informal Conference Worksheet, describing in detail the specific error(s) of fact or law identified by the claimant or representative
complete a new decision for all HLR issues
if applicable, provide a copy of this worksheet to the claimant’s accredited representative, and
associate the worksheet with the Veteran's eFolder.

Important: 38 CFR 3.2601 notes that the decision maker with authority over the issues must be the one to conduct the informal conference, except under exceptional circumstances. "Exceptional circumstances" are significant events such as, but not limited to, the employee resigning or retiring from VA, reassignment to another position that does not have decision making authority, or an extended period of leave (for example, maternity leave for several months).

In the event that the employee who completed the informal conference is unable to render the final decision, follow the steps in the table below.

Step	Action
1	Contact the claimant or representative by telephone to explain that the employee who conducted the informal conference is unable to render the final decision. Only one attempt to contact the claimant and/or representative is required.
2	Ask the claimant to elect one of the following options: take part in a new informal conference with a different decision maker Follow the steps in the scheduling table in M21-5, Chapter 5, Topic 3.h, add the tracked item for the scheduled informal conference, and continue following the remaining steps to complete the scheduling action forego a new informal conference, with the understanding that the new decision maker will review and consider all notes (such as the HLR Informal Conference Worksheet) from the initially completed informal conference Document the election on VA Form 27-0820 and upload to the eFolder.
3	If neither the claimant nor authorized representative can be reached, the new decision maker may proceed with the final decision, while ensuring that all available notes from the informal conference are reviewed and considered. Enter a permanent note in VBMS annotating the attempted contact and that neither the claimant nor representative (if applicable) could be reached.

Note: While the addition of an HLR Informal Conference Worksheet does not technically constitute "new evidence considered," list it nevertheless as evidence in the decision document. Using the completed HLR Informal Conference Worksheet, the decisionmaker should explain in the HLR rating decision narrative why VA’s earlier decision had a factual error, based on the evidence that was available at that time, especially if explaining the error helps support the HLR decision. The decisionmaker can and should consider the arguments obtained by the informal conference in the rating decision narrative. Refer to M21-5, Chapter 5, Topic 4 for further information on new evidence standards.

Reference: For more information on necessary system updates for scheduling informal conferences, see M21-5, Chapter 5, Topic 3.h.

5.3.h. Informal Conference Scheduling

The following procedures outline the steps for scheduling an informal conference, including both telephonic scheduling and Veteran/representative self-scheduling through the Visitor Engagement Reporting Application (VERA).

A self-scheduling or other electronic solicitation does not constitute an official attempt to schedule the informal conference; if the claimant or representative does not self-schedule through VERA, attempt to contact the appropriate parties by telephone to schedule the informal conference.

All scheduling efforts, whether telephonic or self-scheduled, must be documented and updated in accordance with systems compliance requirements.

Step	Action
1 - Initial Actions	Confirm on the VA Form 20-0996 that the informal conference was requested. Verify the HLR - Informal Conference tracked item is added under the correct EP. Verify the Informal Conference special issue is attached to at least one contention. Verify the claim status shows as "Open." Check VERA to see if the informal conference is scheduled: If the informal conference is scheduled in VERA, go to step 2A. If the informal conference is not scheduled in VERA, go to step 2B. *Note: If an informal conference was not* requested on the VA Form 20-0996: Remove the Informal Conference special issue. Mark the HLR - Informal Conference tracked item "In Error." Complete the Work Item, selecting "Ready for Decision" as the claim status. To have the claim remain assigned to you, select your name as the assignment. Reference: For more information on verifying informal conference selections in VA Form 20-0996, see M21-5, Chapter 5, Topic 3.d.
2A – Informal Conference is Self- Scheduled in VERA	Add the tracked item HLR – Scheduled Informal Conference. Enter the date of scheduled informal conference under the HLR – Scheduled Informal Conference tracked item suspense date. Enter the date of the successful contact (i.e., date the informal conference is scheduled in VERA) into the “Received Date” column under the HLR – Informal Conference tracked item. Once the informal conference is held, go to Step 8. If the Veteran or representative is a “no show” for the day and time of the scheduled informal conference, go to Step 9. Note: If it is self-scheduled, do not input a date into “Follow Up 1” or “Follow Up 2” for the HLR – Informal Conference tracked item. An electronic attempt to schedule an informal conference does not constitute an official attempt to schedule the informal conference.
2B - Initial Attempt to Schedule the IC	Proceed with this step if VERA does not show a scheduled informal conference. Initiate the first telephonic attempt to schedule the informal conference. Enter the date of the initial attempt into the "Follow Up 1" column under the HLR - Informal Conference tracked item. If contact is successful and the informal conference is scheduled, move to step 3. If the claimant cannot be reached and the informal conference is not scheduled, move to step 4.
3 - Initial Attempt to Schedule the IC - Successful, IC Scheduled	Add the tracked item HLR - Scheduled Informal Conference. Enter the date of the scheduled IC under the HLR - Scheduled Informal Conference tracked item suspense date. Enter the date of the successful contact into the "Received Date" column under the HLR - Informal Conference tracked item. Update VERA with the scheduled informal conference. Go to step 8 once the informal conference is held. If the Veteran and representative (if one is appointed) are a “no show” for the day and time of the scheduled informal conference, go to step 9.
4 - Initial Attempt to Schedule the IC - Unsuccessful	Update the HLR - Informal Conference tracked item suspense date for the second attempt in three business days. Please refer to the Note in M21-5, Chapter 5, Topic 3.e for counting business days and required VBMS notes/electronic folder documentation. Proceed to step 5.
5 - Second Attempt to Schedule the IC	Make the second telephone attempt to schedule the informal conference. Enter the date of the second attempt into the "Follow Up 2" column under the HLR - Informal Conference tracked item. If contact is successful and the informal conference is scheduled, move to step 6. If the claimant cannot be reached and the informal conference is not scheduled, move to step 7.
6 - Second Attempt to Schedule the IC - Successful, IC Scheduled	Add the tracked item HLR - Scheduled Informal Conference. Enter the date of the scheduled IC under the HLR - Scheduled Informal Conference tracked item suspense date. Enter the date of the successful contact into the "Received Date" column under the HLR - Informal Conference tracked item. Update VERA with the scheduled informal conference. Go to step 8 once the informal conference is held. If the Veteran and representative (if one is appointed) are a “no show” for the day and time of the scheduled informal conference, go to step 9.
7 - Second Attempt to Schedule the IC - Unsuccessful	Mark the HLR - Informal Conference tracked item as "Closed" with the date of the second attempt. Complete the Work Item, selecting "Ready for Decision" as the claim status. To have the claim remain assigned to you, select your name as the assignment *Reference*: For more information on unsuccessful attempts to schedule an informal conference, see M21-5, Chapter 5, Topic 3.f.
8 - Successfully Completed IC	Mark the HLR - Scheduled Informal Conference tracked item as "Received" with the date of the informal conference. Complete the Work Item, selecting "Ready for Decision" as the claim status and your name as the assignment. Update VERA accordingly. *Reference:* For information on updating VERA, see VERA User Fundamentals.
9 - No Show	Make three attempts, approximately five minutes apart, to contact the other party. If the other party does not attend after the third attempt, classify the informal conference as a no-show. A no-show occurs when the other party fails to attend despite multiple contact attempts. In VERA, mark the appointment as "No-Show" for the scheduled time. Document the attempts to contact the other party of VA Form 27-0820, Report of General Information, and upload to the VBMS eFolder. Mark the HLR - Scheduled Informal Conference tracked item as "Closed" with the date of the informal conference. Complete the Work Item, selecting "Ready for Decision" as the claim status and your name as the assignment.

5.3.i

Self-Scheduled Conference on Ineligible HLR

In instances where the HLR is established and the informal conference is self-scheduled by the Veteran or representative, but the HLR is then determined to be ineligible, follow the steps in the table below.

Step

Action

1 - Cancel the informal conference

If the HLR is determined to be ineligible prior to the scheduled informal conference, the informal conference should be formally cancelled.
Update VERA accordingly.

Reference: for information on updating VERA, see VERA User Fundamentals.

2 - Document the cancellation

The informal conference cancellation must be documented in VBMS, indicating that the conference was scheduled but not held due to the ineligibility of the HLR.
- Document on a VA Form 27-0820, Report of General Information and upload into VBMS.
Add a VBMS claim note of the informal conference cancellation.

Refer to M21-5, Chapter 4, Topic 2, f to notify the claimant and address the EP030.

4. Attempts to Introduce New Evidence

Introduction

This topic contains information on handling attempts to introduce new evidence during the HLR, including

Change Date

April 14, 2026

5.4.a. Handling New Evidence

If a claimant submits evidence following the closure of the evidentiary record, the reviewer will notify the claimant or representative in the final decision document that VA received the additional evidence but could not consider it. This prohibition of considering new evidence extends even to when that evidence might otherwise warrant a grant of benefits.

Document any evidence received but not considered in the HLR by adding the following statement to the decision Introduction in VBMS-Rating (VBMS-R):

Please note: The evidentiary record closed on the date of notice of our prior decision. VA received additional evidence, which was not part of that decision after the record closed. If you would like VA to consider this evidence, you may submit a supplemental claim at any time; however, VA must receive your application within one year of the date of notice of this decision to preserve your right to receive the maximum possible benefit.

5.4.b. Attempts to Introduce Evidence During an Informal Conference

During an informal conference, a requester or representative may wish to add to the evidentiary record or request review of evidence outside the scope of the HLR. If the requester or representative submits an argument in reference to evidence that was of record at the time of date of the notification of the decision under review, then it can be considered by the reviewer.

However, if the submitted argument is considered lay evidence or introduces new facts, then it cannot be considered as part of the closed evidentiary record of an HLR. If this is the case, inform the requester of the closed evidentiary record.

If the requester or representative insists on submitting the evidence, the higher-level reviewer may accept it but will inform the requester or representative that the reviewer cannot consider it. The requester or representative may submit a supplemental claim after receiving notification of the HLR decision.

5.4.c. Documenting Evidence Not Considered

A claimant/representative may insist that VA retain the new evidence, even after VA has stated it will not consider that evidence in the HLR. VA employees may assist subsequent decisionmakers by indicating that the eFolder contains unconsidered evidence by:

ensuring the evidence is properly uploaded to the eFolder, and
editing the subject line of the relevant document(s) using the following format: Evidence not considered in HLR of [date].

Subsequent decisionmakers who consider that evidence should re-edit the subject line: Evidence considered in decision of [date].

Reference: For more information on uploading documents to the eFolder and editing document properties, see the

5.4.d. Differentiating Between Argument and Evidence

The higher-level reviewer should remember that argument is not evidence. The closed evidentiary record of an HLR precludes the consideration of new evidence, but it permits the consideration of new argument.

Evidence is every type of proof offered to establish a fact. In an HLR, a claimant or representative may not introduce new facts or new evidence, whether medical or lay. When the claimant or representative attempts to submit new evidence in an HLR, the reviewer must remind the claimant or representative that the record is closed. If the claimant or representative still insists on submitting the evidence, the higher-level reviewer may accept it, but the reviewer will also inform the claimant or representative the reviewer cannot consider it. The claimant or representative may submit a supplemental claim based upon the new evidence after receiving notification of the reviewer's HLR decision.

Argument is the attempt to persuade someone to a particular view or belief using reason and facts. A claimant or representative may properly add, and the reviewer may properly consider, new argument to pinpoint or highlight VA's potential misreading of facts, or its potential misapplication of law to the facts that the evidentiary record has already established.

Reference: For more information on evaluating evidence, see M21-1, Part V, Subpart ii, 1.A.1.d.

5. Errors in the Duty to Assist

Introduction

This topic contains information on errors VA made in its duty to assist the claimant obtain evidence to support the prior claim, including

Change Date

June 12, 2026

5.5.a. Definition of Duty to Assist (DTA) Errors

An HLR may identify a deficiency in VA fulfilling its duty to assist (DTA) the claimant in obtaining evidence relevant to the decision under review. A DTA error is a failure during the processing of the reviewed decision to properly apply the provisions of 38 CFR 3.159 for gathering evidence. These deficiencies include omitting development or failing to request certain examinations. The reviewer must return the issue(s) for development, unless the maximum benefit can be granted, as defined in M21-5, Chapter 5, Topic 5.b.

Important: Apply the procedures for correcting DTA errors when also developing to decide downstream issues of a grant of benefits not yet fully implemented but indicated as favorable findings.

Reference: For instructions on handling evidence received after the date of the notification of the decision under review that triggers VA’s duty to assist, see M21-5, Chapter 5, Topic 4.a.

5.5.b. Definition of Maximum Benefit

Maximum benefit is the highest schedular evaluation allowed by regulation for the issue under review. For ancillary benefits, an award of the benefit sought is the maximum benefit.

Important: HLRs need to consider downstream issues when granting any benefit. The highest schedular evaluation applies even if the issue is SC, as VA considers evaluation to be a downstream issue of SC.

5.5.c. Missing VA Treatment Records

A DTA error may occur when the Veteran or representative alleges treatment at a VA facility, but the records were not properly associated with the eFolder and considered prior to VA issuing notification of its decision, so that decision did not list those records as evidence. The higher-level reviewer must return any affected issue(s) for correction unless the reviewer can grant the maximum benefit.

Note: Constructive notice of VA medical evidence exists when the claimant relates its specific existence and location. The mere existence of medical evidence somewhere in a VA system of records does not constitute constructive notice, and therefore cannot qualify as a DTA error. Rather, the claimant or representative must provide information sufficient to locate such records.

Reference: For more information on constructive notice, see 38 CFR 3.103(c)(2)(iii).

5.5.d. Returning DTA Errors for Correction

A higher-level reviewer who finds a DTA error will complete a VA Form 20-0999, Higher-Level Review Return, for the affected issue(s). Complete the Favorable Findings section of VA Form 20-0999, or, if a rating issue, use VBMS-R, as necessary to justify the development to resolve downstream or reasonably raised secondary issues that may result from a grant of benefits not yet fully implemented.

All relevant details must be provided when returning the affected issue (s):

Manual reference(s),
Identified DTA error(s) resulting in the reason for the return, and
Relevant e-folder document bookmarks.

The return of a request to correct a DTA error concludes the HLR for that issue. Veteran Service Representatives (VSRs) and Rating VSRs (RVSRs) will then treat that issue like any claim requiring development.

Under the Your Benefit Information section of the decision notice, the reviewer will include the statement below to notify the claimant of the disposition of those issue(s).

We completed your request for higher-level review on the following issue(s):

[Insert Issue]
[Insert Issue]

However, we need to develop for additional evidence before we can properly decide your claim.

Note: Use this decision notice only when VA decides at least one issue.

5.5.e. Handling DTA Errors

Follow the procedures in the table below when an HLR identifies missed development or other DTA error.

Note: Generate a decision for any issue not affected by the required development action(s).

Step	Responsible Employee	Action
1	Higher-level reviewer	Can the maximum benefit be granted for any issue affected by the DTA error? If yes, generate a decision for the issue(s) that can be granted, and proceed to the next step for any remaining issue. If no, proceed to the next step. *Reference: See HLR Returns Job Aid*.
2	Higher-level reviewer	Complete VA Form 20-0999 for any remaining issues documenting any relevant evidence, if applicable, detailing the development actions needed Complete any rating decision in VBMS-R and at finalization assign the applicable DTA error disposition for each contention of the HLR. upload the form to the eFolder, and refer the claim to a VSR. Note: Free text should be used to fully explain the reason for the DTA error.
3	VSR	Promulgate EP 030 in VBMS-Awards (VBMS-A) Note: For full DTA error returns (i.e., all contentions require additional development), stations should send a copy of the rating decision and notification letter to the Veteran and representative, if any, with the following wording in the first paragraph of the notification letter: VA completed your request for higher-level review and identified an error in assisting you in gathering evidence to support your claim in each of your claimed conditions. VA will provide you notification of the evidence we will obtain to address these errors under a separate cover. *Note*: Select both "Suppress Appeal Rights VA Form 20-0998" and "Suppress Board Appeals Rights Statement" in VBMS-A.
4	VSR	Once VBMS automatically establishes an EP 040 after authorization, the development VSR will verify the creation of the appropriate claim label: HLR DTA Error – Rating, or HLR DTA Error – Non-Rating *Note: the date of claim will be the date the EP 030 closed. Send the HLR DTA* letter to the Veteran if the development does not require a subsequent development letter (for example, requesting an exam or clarifying a medical opinion). If generating a subsequent development letter based on the action required, add the following: VA completed your request for higher-level review and identified an error in assisting you in gathering evidence to support your claim. VA will correct this error by taking the following actions:

Note: HLR returns (DTA errors and Differences of Opinion) will be routed to VSCs by NWQ for development and subsequent decision on the issue(s).

References: For more information on

Actions for ready to work non-rating claims, see M21-4, Appendix D, Topic 2.f
Positions with the authority to make HLR decisions, see M21-5, Chapter 4, Topic 1.c

5.5.f. Expediting the Correction of DTA Errors

VSRs, authorizers, and RVSRs must expedite HLRs returned for correcting DTA errors.

Reference: For more information on expediting DTA error corrections, see

38 CFR 3.2502, or
Public Law 115-55, Section 5109B.

5.5.g. Proper Tracking of DTA Errors

To ensure proper tracking, when the higher-level reviewer returns a claim to correct a DTA error, users must ensure the selection of the correct disposition in connection to the decision.

Decision/Supplemental Decision	Disposition
Grant of benefits	Grant
Denial of benefits Confirmed - No error Confirm and Continue Decision/Evaluation	Denial
DTA Error - Exam/MO	DTA Error - Exam/MO
DTA Error - Federal Records	DTA Error – Fed Recs
DTA Error - Other Records	DTA – Other Recs
DTA Error - Private Medical Records	DTA Error-PMRs
Difference of Opinion	Difference of Opinion

When generating an award for an HLR, users must review the claim and the VBMS-R codesheet to confirm the decision matches the disposition generated in VBMS Awards.

If the disposition in VBMS Awards is different than the supplemental decision on the codesheet, return the rating for correction.

Note: All contentions on an HLR decision must have a disposition.

6. Non-Rating Issues

Introduction

This topic contains general information on higher-level reviews for non-rating issues, including

Change Date

October 23, 2023

5.6.a. Completing Non-Rating HLRs

Higher-level reviewers use VBMS-R to generate rating decisions. As of October 23, 2023, all non-rating HLR decisions are generated in VBMS-Awards.

5.6.b. Releasing Non-Rating HLR Decisions

The NR AMA Decision will be uploaded to VBMS once complete.

A copy of the NR AMA Decision will be enclosed with the decision letter.

7. Tracking Higher-Level Reviews

Introduction

This topic contains information on tracking HLRs, including

Change Date

April 14, 2026

5.7.a. EP and Claim Labels

The following table is an overview of the EP and claim labels for processing HLRs:

EP and Claim Label Code	Use for
030HLRR	Higher-Level Review Rating
030HLRNR	Higher-Level Review Non-Rating
030BGNR	Board Grant Non-Rating
030BGR	Board Grant Rating
030HLRRPMC	Pension Management Center (PMC) Higher-Level Review Rating
030HLRNRPMC	PMC Higher-Level Review Non-Rating
030BGRPMC	PMC Board Grant Rating
030HBD	Higher-Level Review Birth Defect
030HSB	Higher-Level Review Spina Bifida
030HLRFID	Fiduciary Higher-Level Review

5.7.b. Quality Control EP and Claim Labels

The following table is an overview of claim labels assigned because of quality reviews of HLRs at DROCs/Veterans Service Centers (VSCs) and PMCs. When quality reviews indicate that VA needs to correct errors made in processing HLRs, claims processors should establish the EP 930 in VBMS and ensure the appropriate claim label is assigned.

DROC/VSC Claim Labels	PMC Claim Labels
AMA HLR Rating Control 930AMAHRC	AMA PMC HLR Rating Control 930AMAHRCPMC
AMA HLR Non-Rating Control 930AMAHNRC	AMA PMC HLR Non-Rating Control 930AHNRCPMC
AMA HLR Correction of Rating LQE 930AMAHCRLQE	AMA PMC HLR Correction of Rating LQE 930AHCRLQPMC
AMA HLR Correction of Non-Rating LQE 930AHCNRLQE	AMA PMC HLR Correction of Non-Rating LQE 930AHCNRLPMC
AMA HLR Correction of Rating NQE 930AMAHCRNQE	AMA PMC HLR Correction of Rating NQE 930AHCRNQPMC
AMA HLR Correction of Non-Rating NQE 930AHCNRNQE	AMA PMC HLR Correction of Non-Rating NQE 930AHCNRNPMC
	AMA PMC HLR DTA Error Non-Rating- Correction of LQE 930AHDENLPMC
	AMA PMC HLR DTA Error Non-Rating- Correction of NQE 930AHDENNPMC
	AMA PMC HLR DTA Error Non-Rating 930AHDENRPMC
	AMA PMC HLR DTA Error Rating 930AHDERPMC
	AMA PMC HLR DTA Error Rating- Correction of LQE 930AHDERLPMC
	AMA PMC HLR DTA Error Rating- Correction of NQE 930AHDERNPMC

Note: LQE is Local Quality Error and NQE is National Quality Error.

When an EP 930 is used to correct an HLR and a DTA error is identified, the higher-level reviewer making the correction will return the DTA contentions for additional development. The resulting EP 040 will be automatically established by VBMS. The date of the EP 040 will be the date the EP 930 was cleared.

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