What Decisions Can Be Appealed?
Any claimant for benefits administered by VA has a right to appeal adverse decisions by the agency. See 38 U.S.C. § 7104. In general, the following types of claims are appealable:
- Compensation benefits
- Pension benefits
- Medical care eligibility
- Medical expense reimbursement
- Waiver of recovery of overpayment
The primary exceptions to a claimant’s appellate rights concern medical decisions. For example, a claimant may complain about medical decisions concerning his care and treatment, such as the types of therapy, medications, and treatment protocol. Most of these issues that are within the domain of the medical judgment of a treating physician are outside the scope of the BVA’s jurisdiction. In general, the Board’s appellate jurisdiction extends to issues concerning eligibility for hospitalization, outpatient treatment, nursing home or domiciliary care, for prosthetic devices, canes, wheelchairs, back braces, etc. On the other hand, medical determinations such as appropriateness of certain types of care are “not adjudicative matters and are beyond the Board’s jurisdiction.”