Appeal or Supplemental Claim?

File a Supplemental Claim (VA Form 20-0995) with new and relevant evidence; this is your best course as it does not jeopardize your current 90% rating and allows you to submit crucial new evidence from the missed appointment. Pursuing a higher rating for a mental health condition, evaluated under 38 CFR § 4.130, Diagnostic Code 9400, 9434, etc., will not automatically reduce your current evaluation; the VA cannot reduce a rating solely for seeking an increase unless a review reveals improvement in your condition (see 38 CFR § 3.105(e)). Your immediate action is to gather "new and relevant evidence" as defined in 38 CFR § 3.2501, specifically: 1) obtain and submit a detailed, current DBQ (Disability Benefits Questionnaire) and nexus letter from your treating psychiatrist or psychologist that addresses the severity of your symptoms—particularly focusing on occupational and social impairment—to meet the 100% criteria (e.g., total occupational and social impairment, persistent danger of self-harm); and 2) submit a personal statement on VA Form 21-4138 detailing your symptoms and the occupational impact, explaining the circumstances of the missed appointment (e.g., symptom exacerbation) as further evidence of impairment. Case law like *DeLuca v. Brown* supports the consideration of functional loss during flare-ups, which your evidence should document. Do not request a Higher-Level Review or Board Appeal at this stage, as you likely lack the necessary medical evidence in the current file to succeed. **Disclaimer: This is educational information for claims strategy based on VA regulations and should not be construed as legal or medical advice; for personalized guidance, consult an accredited VA attorney or claims agent.**