VA Form 4107C, Your Rights to Appeal Our Decision - Contested Claims, is a document describing the appeal process on a contested claim. A contested claim exists when two persons file a claim for the same benefit and/or allege to be a veteran's surviving spouse or parent. A favorable decision on one contested claim means the denial of the other claim or a lower payment to the other claimant. Additionally, one of the claimants has a right to contest the payment or allowance of that benefit to one or a few of the other claimants. There must be a formal claim and a protest against payment to one or a few of the other claimants for a claim to be considered contested.
The latest version of the VA 4107C Form was released by the Department of Veterans Affairs (VA) on June 1, 2017, with all previous editions obsolete. A printable VA Form 4107C is available for download below or can be found through the VA website.
VA Form 4107C explains how claimants can appeal and how they can send the VA more evidence, if necessary. It is possible to choose either one or both of these options.
To start the appeal process, a claimant must send VA Form 21-0958, Notice of Disagreement to the VA. If the claim is not granted then, the VA replies with the attached Statement of the Case which contains the justification of their decision. Form 4107C also recommends visiting the VA website to find a "plain language" pamphlet describing the appeal process.
VA Form 4107C allows claimants to send to the VA supplementary evidence in support of the claim. It must be directed to the address given in the VA's decision notice letter. There are two ways to present evidence. A written response is usually reserved for documents and written statements with an explanation of how they can change the initial decision. There is also an option to request a personal hearing with a local VA office employee, where written evidence can be shared and witnesses can speak on a claimant's behalf. Any new evidence is reviewed by the VA, and then they let the claimant know if they can grant a claim. If it is not the case, the new evidence along with the record of a local hearing is sent to the Board of Veterans' Appeals.
VA 4107 Related Forms: