VA Form 4107VHA, Your Rights to Appeal Our Decision is a document describing how to appeal decisions made by the Veterans Health Administration (VHA). It covers health benefit (medical) appeals which include outpatient treatment, eligibility for hospitalization, nursing home, and domiciliary care. The VHA is the largest health care system in the United States which enrolls more than 9 million veterans across the country.
The latest version of VA 4107VHA form was released by the Department of Veterans Affairs (VA) in June 2016 with all previous editions obsolete. A printable VA Form 4107VHA fillable version is available for download or can be found through the VA website.
This form applies to three categories of claims: