VA Form 4107INS Your Rights to Appeal Our Decision

VA Form 4107INS Your Rights to Appeal Our Decision

What Is VA Form 4107INS?

VA Form 4107INS, Your Rights to Appeal our Decision, is a document used by veterans to appeal against the Department of Veterans Affairs (VA) decision to deny an insurance claim. The latest version of the form was released on May 1, 2017, with all previous editions obsolete. A VA Form 4107INS fillable version is available for download or can be found through the VA website.

Alternate Name:

  • VA Decision Appeal Form.

In accordance with Form 4107INS, a veteran can choose to have representation. A list of Veterans Service Organizations to represent veterans' interests for free can be found online on the VA website. Additionally, an "agent" or an attorney can represent the veteran, although these services may not be free of charge.

The VA Decision Appeal Form states a veteran has one year to appeal to the Board of Veterans' Appeals using VA Form 21-0958, Notice of Disagreement, or six years to challenge the VA's decision by lodging a complaint with a district court.


Your Rights to Appeal Our Decision

According to the VA appeal form, there are three possible routes to take if a veteran disagrees with a decision:

  1. Submitting new evidence in support of the claim. A veteran has a right to send any supplementary evidence to support the application or claim to the address given in the VA letter. Once the evidence has been received, the VA lets a veteran know whether it changes the initial decision.
  2. Appealing. To commence this process, a veteran must write a letter informing the VA about disagreeing with the decision. This letter is called a Notice of Disagreement. It is possible to send additional evidence with the Notice to the address given in the VA letter. The VA will review the documents and will let the veteran know whether a new decision has been made. If an application or a claim cannot be approved, the VA will send a letter notifying the veteran of this decision and asking if the veteran wants to continue the appeal or withdraw it. In the former case, the VA sends the veteran a Statement of the Case that describes the facts, reasons, laws, and regulations they used to make a decision and a VA Form 9, Appeal to Board of Veterans' Appeals.
  3. Challenging the VA's decision at the federal court. A veteran is eligible to file a complaint in the United States District Court.

VA 4107 Related Forms:

Download VA Form 4107INS Your Rights to Appeal Our Decision

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  • VA Form 4107INS Your Rights to Appeal Our Decision, Page 1