A Higher-Level Review (HLR), filed on VA Form 20-0996, is generally the right tool when you believe the VA had all the correct evidence in front of it but misapplied the law, regulation, or rating schedule. It is a paper review by a more senior adjudicator who looks only at the evidence already in the file at the time of the decision being challenged — no new evidence can be submitted, though you can request a one-time informal conference to explain why you think the rating criteria were misapplied. This makes it well suited to situations where the dispute is essentially about interpretation of the diagnostic code, rather than about needing new medical evidence.
For skin conditions like hidradenitis suppurativa, ratings fall under 38 CFR 4.118, and several diagnostic codes (including those referencing constant or near-constant systemic therapy such as immunosuppressive or biologic drugs) can support higher schedular ratings than a rating based solely on affected body surface area or localized symptoms. If the evidence in the file already documents ongoing systemic biologic therapy and the rating decision does not appear to have considered that criterion, an HLR is a reasonable next step. If the file is missing updated treatment records showing the systemic therapy timeline, a Supplemental Claim (VA Form 20-0995) with new evidence may be more appropriate instead of, or after, an HLR.
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 →For a condition noted at entry, like flat feet, the key legal question is whether the presumption of soundness applies and, if the condition pre-existed service, whether it was aggravated beyond its natural progression by service duties (38 USC 1111 and 38 CFR 3.306). Evidence of in-service aggravation — such as duty-related physical demands and post-service treatment like orthotics — can support a claim, but this typically requires a new nexus opinion rather than a pure legal-error argument, making it better suited to a Supplemental Claim than an HLR.
Because HLR, Supplemental Claim, and Board Appeal each serve different purposes and only one can be pursued per issue at a time under the Appeals Modernization Act, a veteran in this situation should carefully separate each contested issue, identify whether the dispute is over evidence or over application of the law, and choose the corresponding appeal lane for each one rather than filing a single blanket appeal for all issues.
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