What's happening with your claim?
What the tool diagnoses
OperationAppeal helps with VA claims, TRICARE billing, disability ratings, PACT Act presumptives, and the full range of veteran benefits paperwork. It reads your uploaded decision, EOB, or denial letter and identifies the specific regulations, billing rules, or presumptive paths that apply. Three illustrative examples below — your actual analysis will be tailored to whatever document you submit.
What you'll actually receive: one Word .docx file per appeal letter your case requires (typically 3–7 letters in total, plus a filing checklist). Each letter follows the same format as the samples below — opens in Word, Google Docs, Pages, or any major word processor, and is fully editable before you file.
Lumbosacral strain rated at 10% — should be 20%. Your C&P exam documented muscle spasm with abnormal gait. Under 38 CFR §4.71a (Diagnostic Code 5237), those exam findings meet the 20% criterion, not 10%. The tool quotes the exam language, matches it to the CFR rating-tier text, and flags the gap so your appeal letter can cite both side by side.
📄 Preview the letter$4,200 ER bill denied as "not medically necessary" — should be paid. You went to the ER for severe chest pain. TRICARE denied citing routine non-emergent care. The prudent-layperson standard at 32 CFR §199.4(g)(13) requires payment whenever an average person would reasonably believe their symptoms warrant emergency care — chest pain meets that threshold. The tool drafts the appeal citing the correct CFR provision and the EMTALA precedent.
📄 Preview the letterGulf War-era respiratory condition denied for "lack of nexus" — should be presumptive. If you served in Southwest Asia from August 1990 onward and have a qualifying respiratory condition (chronic bronchitis, COPD, asthma, etc.), 38 CFR §3.320 establishes presumptive service connection — no nexus letter required. VA mistakenly applied the higher direct-SC standard. The tool catches denials that should have been granted under PACT Act expansions and drafts the appeal accordingly.
📄 Preview the letterOther case types the tool handles: CUE (clear and unmistakable error), TDIU eligibility, secondary service connection, effective-date disputes, duty-to-assist violations, stale C&P exams, C-file FOIA recommendations, prior-auth denials, and coordination-of-benefits issues across VA / TRICARE / Medicare / private payers.