A Higher-Level Review (HLR), requested on VA Form 20-0996, asks a more senior rater to take a fresh look at a prior decision using the evidence already in the file at the time of that decision. Unlike a supplemental claim, HLR generally does not allow new evidence to be submitted — the reviewer is checking for clear and unmistakable error, differing interpretation of the existing record, or a duty-to-assist error that occurred before the decision (for example, if VA failed to schedule an adequate exam or test that was needed to fairly rate the condition). If a stress test or exercise-tolerance testing was medically indicated to evaluate a cardiac condition under 38 CFR 4.104 and was not done, that omission can sometimes be raised as a pre-decisional duty-to-assist error, which is one of the few ways additional development can still occur inside the HLR lane.
Requesting an informal conference with the higher-level reviewer is a good step — it is a phone conversation, not a hearing, where the veteran or representative can explain what evidence already exists in the file, point out specific pages, and argue why the exam that was performed was inadequate (for example, an EKG and ultrasound alone may not capture MET-level limitation the way a supervised stress test or the veteran's own METs-equivalent activity tolerance would, when tied to a diagnostic code like 7010 for supraventricular tachycardia, which is rated based on documented arrhythmia episodes and resulting workload capacity in METs).
Official 2026 VA monthly compensation, including the 2.8% COLA increase.
Dependent add-ons start at a 30% rating. Child-only and dependent-parent rates: see the full 2026 pay chart.
| Rating | Monthly (2026, incl. 2.8% COLA) |
|---|---|
| 10% | $180.42 |
| 20% | $356.66 |
| 30% | $552.47 |
| 40% | $795.84 |
| 50% | $1,132.90 |
| 60% | $1,435.02 |
| 70% | $1,808.45 |
| 80% | $2,102.15 |
| 90% | $2,362.30 |
| 100% | $3,938.58 |
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Analyze my claim free →Supraventricular tachycardia and related cardiac conditions are rated under 38 CFR 4.104, where the criteria hinge on objective findings such as workload in METs, cardiac hypertrophy or dilation, and congestive heart failure episodes. A Holter monitor showing documented tachycardia episodes, treating-physician statements correlating symptoms to METs level, and a clear description of functional limitations (falls, inability to shower or drive, syncope) all strengthen the record, though whether an adequate cardiac exam already exists is central to whether HLR or a supplemental claim with new evidence is the better path forward.
In the appealed VA decisions in VetAid's library, increased-rating disputes that reached an appellate disposition were vacated or remanded 54% of the time, affirmed (denial upheld) 26% of the time, and reversed or granted outright 7% of the time — keeping in mind these are outcomes for cases that were already appealed, not the odds of any initial claim succeeding, and appealed cases are not a random sample of all filings.
The concrete next step is to use the informal conference specifically to argue that the cardiac exam was inadequate for rating purposes under 4.104 and to request either correction under HLR or, if new medical evidence (like updated Holter results or a cardiologist's MET-level opinion) needs to be added, to consider filing a supplemental claim in parallel.
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