Sample VA Appeal Letter

Posted in Appeal Letters

When writing a VA appeal letter, it is important to make sure you call your area Veteran’s Administration first to find out the name of a VA employee and the proper department to which the appeal should be sent. Any special forms the VA requires for the processing of appeals should be downloaded from their website, completed and attached to your letter.

Format and Content
Most often VA appeal letters are written when individuals are denied disability benefits by the government agency. A VA appeal letter format must include a Notice of Disagreement (NOD) and both should be sent to your regional Veteran’s Administration office. The NOD can be submitted on VA Form 21-4138 along with your letter detailing why you disagree with the VA’s decision to deny benefits. The letter and NOD should include the date of the VA’s decision and the specific issues with which you have a disagreement. You have one year from the VA’s original decision to file your appeal letter with your regional VA office and you may include medical records or other supporting documentation with your appeal.

Military personnel who have been injured or experience medical problems as a result of active duty in defense of the United States have a right to appeal benefit denials such as disability. This VA appeal letter sample is from a former member of the U.S. armed services who received an honorable discharge, but is now suffering from what appears to be post-traumatic stress disorder (PTSD). The individual has not been able to hold down a job and has applied for disability through the VA but has been denied benefits.

Andrew S. Jordan
654 Southwest Street
Columbus, GA 55555
Status: Honorable Discharge
Rank: Private First Class
Serial Number: 987654321
SSN: 123-45-6789
Mr. Jacob Tanner
Appeals Representative
Appeals Department
Veteran’s Administration
321 East Street
Decatur, GA 44444
September 30, 2013
RE: Appeal denial of disability benefits for post-traumatic stress disorder regarding decision of September 15, 2013
Dear Mr. Tanner,
I am writing to issue a formal appeal to the VA’s decision handed down on September 15, 2013 that denies me disability benefits for the post-traumatic stress disorder I now suffer as a result of an ambush in Afghanistan on January 12, 2013. I am the sole survivor of a group of 6 soldiers traveling in a Humvee along the southern border of Afghanistan and northern border Pakistan on January 12, 2013. We were ambushed by Afghan insurgents, shot and left for dead. I was the only survivor and I walked the 2.5 miles back to our base with a bullet lodged in my chest.

I have struggled to hold down a job. I have nightmares and am greatly disturbed by loud noises and bright lights. I also struggle with focusing and concentrating on work assignments and have extreme difficulty effectively handling more than one task at the same time. My medical records are attached along with a letter from my personal physician and my Notice of Disagreement (NOD) on form
21-4138 to the denial of benefits decision issued by the VA on September 15, 2013. I ask that you reconsider the denial and allow me to collect disability benefits while I work to overcome my PTSD. It is my plan to return to the workforce when I am well enough.
Thank you for your consideration.
Andrew Jordan
Andrew S. Jordan
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