20-0995
Decision Review Request: Supplemental Claim
VA Form 20-0995, Decision Review Request: Supplemental Claim, is the U.S. Department of Veterans Affairs form for asking VA to look at a decision again. The form describes a supplemental claim as a new review of an issue previously decided by VA based on new and relevant evidence. The official VA page says to use it if you disagree with a VA decision and want to provide new evidence to support your claim.
Each form covers one benefit type, such as compensation, pension, education or life insurance. It asks for the veteran's and claimant's details, each decided issue with the date of VA's decision notice, and where you were treated so VA can request records. The form also names the other two decision review options: VA Form 20-0996 for a Higher-Level Review and VA Form 10182 for a Board Appeal.
The May 2024 edition has 7 pages: 3 pages of instructions and mailing addresses, then the form. You can fill it out free in your browser on this page and download the result without an account.
One box only: compensation, pension/DIC/survivors benefits, fiduciary, education, loan guaranty, life insurance, Veteran Readiness and Employment, National Cemetery Administration or Veterans Health Administration. A VHA claim also names the benefit, such as travel or mileage reimbursement.
The veteran's name, Social Security number, VA file number, date of birth, service number, VA insurance policy number, mailing address, phone and email. Section II asks the same of a claimant who is not the veteran.
Items 20A to 20D are only for someone who is homeless or at risk of becoming homeless. They ask about the living situation and a point of contact, and the form says VA uses this only to prioritize the request.
Item 21 lists each issue decided by VA that you want reviewed, with the date of VA's decision notice for each. The form says only the issues listed are considered as part of the supplemental claim.
Where you were treated, such as a private provider, a VA Vet Center, community care, a VA medical center or a DOD military treatment facility, with the facility name, location and approximate dates. Dates are not needed for treatment that began from 2005 to present.
Item 23 confirms review of the 5103 evidence notice. Item 24 is an optional consent for VBA to notify VHA about upcoming events in claims involving military sexual trauma. Then come the signature, witnesses, alternate signer and representative.
The form says to refer to your decision notification letter for the list of decided issues and the date of each decision.
Check a single box in Item 1. The form says a separate VA Form 20-0995 is completed for each benefit type.
Enter each issue in Item 21A and the date of VA's decision notice in Item 21B. For a claim filed within one year of a decision by a federal court named on the form, it asks for the court decision date and a copy.
Attach records you have, with your name and file number on each page, or identify records for VA to request. For private provider or Vet Center records, the form asks for VA Forms 21-4142 and 21-4142a.
Sign Item 25A to certify that the statements are true and correct to the best of your knowledge and belief. If the signature is an X mark, two witnesses sign Section IX.
Mail it to the address for your benefit type, take it to a VA regional office, or submit it electronically. The form says to keep a copy of all completed forms and materials you give to VA.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The form lists one address per benefit type. Compensation and loan guaranty go to Department of Veterans Affairs, Compensation Intake Center, P.O. Box 4444, Janesville, WI 53547. Education claims go to the Buffalo or Muskogee Regional Processing Office.
The form says documents may be submitted by mail, in person at a VA regional office or electronically, and that VA recommends electronic submission as the fastest. The VA page says the online Supplemental Claim is available only for disability compensation claims.
The form says that for issues not listed, there is still "one year from the date of the decision notification letter to file a supplemental claim to maintain eligibility for the earliest effective date for any granted benefits." Opting in from an SOC or SSOC is within 60 days of its date.
The form says an accredited attorney or claims agent can generally charge a fee only after VA has issued a decision on a claim.
An accredited representative, such as a Veterans Service Organization, can help complete the form. VA also helps at the number on the decision notification letter or 1-800-827-1000, and the form says a hearing can be requested at any time in the claims process.
20-0996
119 fields, 5 pages
VA10182
27 fields, 3 pages
21-526EZ
345 fields, 15 pages
21-4142
140 fields, 5 pages
21-22
63 fields, 4 pages
The form says it should only be used if you disagree with a decision you received. For a condition that has worsened, it points to VA Form 21-526EZ to request an increased evaluation instead.
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The form describes it as a new review of an issue previously decided by VA, based on new and relevant evidence. It is one of three decision review options the form names, along with a Higher-Level Review and a Board Appeal.
The form says new evidence is information not previously submitted to VA, and relevant evidence is information that tends to prove or disprove a matter at issue in the claim. Unless the claim is based on a change in law, the form says this evidence is needed for the application to be complete.
No. The form covers one benefit type at a time and says a separate VA Form 20-0995 is completed for each benefit type.
The VA page says you can file online instead of sending the paper form, but at this time only for disability compensation claims.
The form says VA has access to VA medical center, community-based outpatient clinic and military treatment facility records without a consent form. For private provider or VA Vet Center records, it asks for VA Forms 21-4142 and 21-4142a.
The form says that if a condition has worsened and the assigned disability level no longer reflects it, VA Form 21-526EZ is used to request an increased evaluation.
The form says that for issues not listed, there is one year from the date of the decision notification letter to file a supplemental claim to maintain eligibility for the earliest effective date for any granted benefits. A response to an SOC or SSOC is within 60 days of its date.
