What can I do if the VA denies surgery or treatment that outside doctors say I need?

A VA decision not to authorize a specific surgery or treatment is a clinical/medical decision made by VA health care providers, not a disability-rating decision, so it follows a different process than a compensation appeal. If a VA facility says a condition does not require surgery but an outside provider (including one seen through community care) disagrees, the first step is to request a formal second opinion within VA or through community care again, and to put the disagreement in writing to the treating physician and the facility's Patient Advocate. Every VA medical center has a Patient Advocate office whose job is to log and escalate disputes about care, including disagreements over whether a procedure is medically necessary. If that does not resolve it, veterans can ask to speak with the Chief of Staff or request a clinical appeal/utilization review of the treatment decision, and can request referral back out to community care under the MISSION Act (38 U.S.C. § 1703) if VA cannot or will not provide timely, appropriate treatment in-house.

Separately, if this hernia is service-connected or is being claimed as service-connected, and years of prior VA exams failed to detect a condition that outside imaging found almost immediately, that new medical evidence can support a Supplemental Claim (VA Form 20-0995) for an increased or corrected disability rating, since new and relevant evidence under 38 CFR § 3.156 can reopen or strengthen a claim. If the veteran believes a past rating decision was based on an inadequate or clearly erroneous VA examination, it may also be worth asking a VA-accredited representative or attorney whether facts support a Clear and Unmistakable Error (CUE) claim under 38 CFR § 3.105(a), though CUE has a high legal bar and is not simply "the exam was wrong." A Higher-Level Review (VA Form 20-0996) or Board Appeal (VA Form 10182) are other options if a specific decision on the disability claim itself is being disputed.

The concrete next step is to get the outside imaging report and any surgeon's treatment recommendation in writing, submit it to VA through the Patient Advocate for the care dispute and, if there is a related disability claim, file a Supplemental Claim (VA Form 20-0995) with that new evidence, ideally with help from an accredited Veterans Service Officer.