VA Form 4107 Your Rights to Appeal Our Decision

What Is VA Form 4107?

VA Form 4107, Your Rights to Appeal Our Decision is a document explaining how to start an appeal with the aid of a Notice of Disagreement. If the Department of Veterans Affairs (VA) was not able to grant some or all of the VA benefits, a veteran, a Veterans Service Organization representative, an attorney-in-law, or an «agent» can begin an appeal process. Additionally, a veteran may give the VA evidence they do not possess that may lead them to change their initial decision.

VA 4107 states that a veteran can get someone to help with the appeal. However, veterans are not required to have representation. Veterans Service Organizations will represent the applicant for free; however, it might be necessary to pay to an attorney or an agent. The VA only recognizes attorneys licensed to practice law in the United States and/or its territories. An agent is an individual who the VA recognizes as someone who knows veterans' law.

VA Form 4107 points out that the appeal must be started on time. Once the VA decision is final, it is not possible to get the benefit.

The latest version of the notice was released by the VA in June 2016 with all previous editions obsolete. A printable VA Form 4107 is available for download below.

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YOUR RIGHTS TO APPEAL OUR DECISION
After careful and compassionate consideration, a decision has been reached on your claim. If we were not
able to grant some or all of the VA benefits you asked for, this form will explain what you can do if you
disagree with our decision. If you do not agree with our decision, you may:
Start an appeal by submitting a Notice of Disagreement.
Give us evidence we do not already have that may lead us to change our decision.
This form will tell you how to appeal and how to send us more evidence. You can do either one or both of
these things.
H
C
I A
D
OW
AN
PPEAL THE
ECISION?
How do I start my appeal? To begin your appeal, you must submit VA Form 21-0958, "Notice of
Disagreement," if that form was provided to you in connection with our decision. If we denied more than one
claim for a benefit (for example, if you claimed compensation for three disabilities and we denied two of
them), please tell us in Part IV of VA Form 21-0958 each of the claims you are appealing. A filed VA Form
21-0958 is considered your Notice of Disagreement. If you did not receive VA Form 21-0958 in connection
with our decision, then write us a letter telling us you disagree with our decision or enter your disagreement on
VA Form 21-0958 in questions 11 or 12A. If you did not receive VA Form 21-0958 in connection with our
decision, then either your statement or VA Form 21-0958 is considered your Notice of Disagreement. Send
your Notice of Disagreement to the address included on our decision notice letter.
How long do I have to start my appeal? You have one year to start an appeal of our decision. Your
Notice of Disagreement must be postmarked (or received by us) within one year from the date of our letter
denying you the benefit. In most cases, you cannot appeal a decision after this one-year period has ended.
What happens if I do not start my appeal on time? If you do not start your appeal on time, our decision
will become final. Once our decision is final, you cannot get the VA benefit we denied unless you either:
Show that we were clearly wrong to deny the benefit or
Send us new evidence that relates to the reason we denied your claim.
What happens after VA receives my Notice of Disagreement? We will either grant your claim or send you
a Statement of the Case. A Statement of the Case describes the facts, laws, regulations, and reasons that we
used to make our decision. We will also send you a VA Form 9, "Appeal to Board of Veterans' Appeals," with
the Statement of the Case. If you want to continue your appeal to the Board of Veterans' Appeals (Board)
after receiving a Statement of the Case, you must complete and return the VA Form 9 within one year from the
date of our letter denying you the benefit or within 60 days from the date that we mailed the Statement of the
Case to you, whichever is later. If you decide to complete an appeal by filing a VA Form 9, you have the
option to request a Board hearing. Hearings often increase wait time for a Board decision. It is not necessary
for you to have a hearing for the Board to decide your appeal. It is your choice.
Where can I find out more about the VA appeals process?
You can find a "plain language" pamphlet called "How Do I Appeal," on the Internet at:
http://www.bva.va.gov/How_Do_I_Appeal.asp.
You can find the formal rules for the VA appeals process in title 38, Code of Federal Regulations,
Part 20. You can find the complete Code of Federal Regulations on the Internet at:
http://www.ecfr.gov. A printed copy of the Code of Federal Regulations may be available at your
local law library.
Y
R
R
OUR
IGHT TO
EPRESENTATION
Can I get someone to help me with my appeal? Yes. You can have a Veterans Service Organization
representative, an attorney-at-law, or an "agent" help you with your appeal. You are not required to have
someone represent you. It is your choice.
Representatives who work for accredited Veterans Service Organizations know how to prepare and
present claims and will represent you. You can find a listing of these organizations on the Internet at:
http://www.va.gov/vso.
4107
VA FORM
(Please continue reading on page 2)
JUN 2016
YOUR RIGHTS TO APPEAL OUR DECISION
After careful and compassionate consideration, a decision has been reached on your claim. If we were not
able to grant some or all of the VA benefits you asked for, this form will explain what you can do if you
disagree with our decision. If you do not agree with our decision, you may:
Start an appeal by submitting a Notice of Disagreement.
Give us evidence we do not already have that may lead us to change our decision.
This form will tell you how to appeal and how to send us more evidence. You can do either one or both of
these things.
H
C
I A
D
OW
AN
PPEAL THE
ECISION?
How do I start my appeal? To begin your appeal, you must submit VA Form 21-0958, "Notice of
Disagreement," if that form was provided to you in connection with our decision. If we denied more than one
claim for a benefit (for example, if you claimed compensation for three disabilities and we denied two of
them), please tell us in Part IV of VA Form 21-0958 each of the claims you are appealing. A filed VA Form
21-0958 is considered your Notice of Disagreement. If you did not receive VA Form 21-0958 in connection
with our decision, then write us a letter telling us you disagree with our decision or enter your disagreement on
VA Form 21-0958 in questions 11 or 12A. If you did not receive VA Form 21-0958 in connection with our
decision, then either your statement or VA Form 21-0958 is considered your Notice of Disagreement. Send
your Notice of Disagreement to the address included on our decision notice letter.
How long do I have to start my appeal? You have one year to start an appeal of our decision. Your
Notice of Disagreement must be postmarked (or received by us) within one year from the date of our letter
denying you the benefit. In most cases, you cannot appeal a decision after this one-year period has ended.
What happens if I do not start my appeal on time? If you do not start your appeal on time, our decision
will become final. Once our decision is final, you cannot get the VA benefit we denied unless you either:
Show that we were clearly wrong to deny the benefit or
Send us new evidence that relates to the reason we denied your claim.
What happens after VA receives my Notice of Disagreement? We will either grant your claim or send you
a Statement of the Case. A Statement of the Case describes the facts, laws, regulations, and reasons that we
used to make our decision. We will also send you a VA Form 9, "Appeal to Board of Veterans' Appeals," with
the Statement of the Case. If you want to continue your appeal to the Board of Veterans' Appeals (Board)
after receiving a Statement of the Case, you must complete and return the VA Form 9 within one year from the
date of our letter denying you the benefit or within 60 days from the date that we mailed the Statement of the
Case to you, whichever is later. If you decide to complete an appeal by filing a VA Form 9, you have the
option to request a Board hearing. Hearings often increase wait time for a Board decision. It is not necessary
for you to have a hearing for the Board to decide your appeal. It is your choice.
Where can I find out more about the VA appeals process?
You can find a "plain language" pamphlet called "How Do I Appeal," on the Internet at:
http://www.bva.va.gov/How_Do_I_Appeal.asp.
You can find the formal rules for the VA appeals process in title 38, Code of Federal Regulations,
Part 20. You can find the complete Code of Federal Regulations on the Internet at:
http://www.ecfr.gov. A printed copy of the Code of Federal Regulations may be available at your
local law library.
Y
R
R
OUR
IGHT TO
EPRESENTATION
Can I get someone to help me with my appeal? Yes. You can have a Veterans Service Organization
representative, an attorney-at-law, or an "agent" help you with your appeal. You are not required to have
someone represent you. It is your choice.
Representatives who work for accredited Veterans Service Organizations know how to prepare and
present claims and will represent you. You can find a listing of these organizations on the Internet at:
http://www.va.gov/vso.
4107
VA FORM
(Please continue reading on page 2)
JUN 2016
A private attorney or an "agent" can also represent you. VA only recognizes attorneys who are
licensed to practice in the United States or in one of its territories or possessions. Your local bar
association may be able to refer you to an attorney with experience in veterans' law. An agent is a
person who is not a lawyer, but who VA recognizes as being knowledgeable about veterans' law.
Contact us if you would like to know if there is a VA accredited agent in your area.
Do I have to pay someone to help me with my appeal? It depends on who helps you. The following
explains the differences.
Veterans Service Organizations will represent you for free.
Attorneys or agents can charge you for helping you under some circumstances. Paying their fees for
helping you with your appeal is your responsibility. If you do hire an attorney or agent to represent
you, a copy of any fee agreement must be sent to VA. The fee agreement must clearly specify if VA
is to pay the attorney or agent directly out of past-due benefits. See 38 C.F.R. § 14.636(g)(2). If the
fee agreement provides for the direct payment of fees out of past-due benefits, a copy of the direct-
pay fee agreement must be filed with us at the address included on our decision notice letter within 30
days of its execution. A copy of any fee agreement that is not a direct-pay fee agreement must be
filed with the Office of the General Counsel within 30 days of its execution by mailing the copy to
the following address: Office of the General Counsel (022D), Department of Veterans Affairs, 810
Vermont Avenue, NW., Washington, DC 20420. See 38 C.F.R. § 14.636(g)(3).
G
VA A
E
IVING
DDITIONAL
VIDENCE
You can send us more evidence to support a claim whether or not you choose to appeal.
NOTE: Please direct all new evidence to the address included on our decision notice letter. You should not
send evidence directly to the Board at this time. You should only send evidence to the Board if you decide
to complete an appeal and, then, you should only send evidence to the Board after you receive written
notice from the Board that they received your appeal.
If you have more evidence to support a claim, it is in your best interest to give us that evidence as soon as you
can. We will consider your evidence and let you know whether it changes our decision. Please keep in mind
that we can only consider new evidence that: (1) we have not already seen and (2) relates to your claim. You
may give us this evidence either in writing or at a personal hearing with your local VA office.
In writing. To support your claim, you may send documents and written statements to us at the address
included on our decision notice letter. Tell us in a letter how these documents and statements should change
our earlier decision.
At a personal hearing. You may request a hearing with an employee at your local VA office at any time,
whether or not you choose to appeal. We do not require you to have a local hearing. It is your choice. At this
hearing, you may speak, bring witnesses to speak on your behalf, and hand us written evidence. If you want a
local hearing, send us a letter asking for a local hearing. Use the address included on our decision notice
letter. We will then:
Arrange a time and place for the hearing
Provide a room for the hearing
Assign someone to hear your evidence
Make a written record of the hearing
W
H
A
I G
VA E
HAT
APPENS
FTER
VIDENCE?
IVE
We will review any new evidence, including the record of the local hearing, if you choose to have one,
together with the evidence we already have. We will then decide if we can grant your claim. If we cannot
grant your claim and you complete an appeal, we will send the new evidence and the record of any local
hearing to the Board.
SUPERSEDES VA FORM 4107, JUN 2015,
BACK OF VA FORM 4107, JUN 2016
WHICH WILL NOT BE USED.

Download VA Form 4107 Your Rights to Appeal Our Decision

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Your Rights to Appeal Our Decision

In accordance with the provisions on the VA 4107, if you disagree with the VA decision, you can start an appeal and give the VA new evidence to change the decision. It is in veterans' best interest to provide the VA with that evidence as soon as possible. The evidence will be considered, and the VA will let you know if it changes their decision. Only the evidence that the VA has not already seen and relates to the claim will be considered. It can be provided either at a personal hearing at the local VA office at any time or in writing. A veteran may choose to speak, bring witnesses, and hand the VA written evidence. The VA decision appeal form stipulates that the VA arranges a time and place for a hearing, provides the room, assigns an official to hear the evidence, and makes a written record of the hearing.

VA Form 4107 Series

The appeal form - formerly known as VA Form 21-4107 - has four other related forms:

  1. VA Form 4107c, Your Rights to Appeal Our Decision - Contested Claims instructs the claimant to send a Notice of Disagreement when denied a claim for a benefit;
  2. VA Form 4107VHA, Your Rights to Appeal Our Decision applies to the Veterans Health Administration claims;
  3. VA Form 4107VRE, Your Rights to Appeal Our Decision applies to claims for vocational rehabilitation and employment benefits;
  4. VA Form 4107INS, Your Rights to Appeal Our Decision is used in cases when the VA denies applications or claims for different insurance policies.
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