Many Veterans we work with are concerned about VA disability rating reviews because it could mean a reduction in their benefits.
However, a review can have several outcomes including no change, a decreased or increased disability rating. If you have concerns in this area and you don’t have a Permanent and Total Rating, it’s best to let us help you take a closer look at your circumstances so we can provide you with appropriate guidance on what to expect.
What is the VA Disability 5-Year Rule?
The VA Disability 5-Year Rule allows the VA to re-examine your disability rating within five years of your initial examination if your condition is expected to improve over time.
The VA can still change your disability after the five-year deadline if your condition has significantly improved. This gives the VA flexibility to make changes because not all types of service-connected disabilities are permanent.
If you have a condition that’s expected to improve over time, the VA will most likely re-evaluate your condition within 2 to 5 years of your initial examination.
Exceptions to the 5-Year Rule
The exceptions to this rule are when Veterans are protected by a Permanent and Total Rating or anyone else with a condition that’s never expected to improve.
For example, a Veteran with a missing limb or who is blind is considered to have a permanent service-connected disability. Exceptions also apply to Veterans over 55 unless regulations require a re-examination. At this age, examinations are rare, except for ratings for certain cancers.
VA disability benefits continue at the same level after a claimant turns 65. VA rules prohibit reductions based simply on increasing age.
How The Five-Year Rule Can Affect Veterans
A re-examination does not automatically mean that your VA disability rating will change.
After a review, a rater may determine whether your rating is still appropriate.
In other instances, the rater may determine that your condition has improved or worsened. In these cases, your disability rating would be adjusted according to the findings.
It’s also worth noting that the VA may still change your disability rating past the five-year deadline if your condition has significantly improved, although this action is uncommon.
How the VA Re-Examines VA Disability Ratings
The VA will schedule an examination to determine if your VA disability rating is still appropriate depending on how much your service-connected disability affects your ability to function and overall quality of life.
If you are contacted for a disability examination under this rule, you must attend your scheduled appointment(s), or the VA will have grounds to reduce or terminate your VA disability benefits.
It’s essential to understand that if your condition has remained the same, the VA will most likely find that your rating is still accurate, and no changes to your disability payments will occur. They will base a decision on the frequency, severity, and duration of your symptoms and how they have changed or not changed since your initial determination.
VA raters must exercise prudent judgment and refer to 38 CFR 3.327(b) in determining the need for review disability examinations. In general, the VA will request future examinations only when necessary and will try to limit cases where future examinations are requested. Specifically, future examinations will not be scheduled when:
- The disability is “Static,” without material improvement over five years,
- The disability is “Permanent” in character and of such nature that there is no likelihood of improvement,
- The Veteran is over 55 years of age (except under unusual circumstances or where required by regulation)
- The evaluation is the prescribed schedular minimum within its diagnostic code, the evaluation is 10% or less, or the combined evaluation would not change even if the VA reevaluation resulted in a reduced evaluation for one or more disabilities.
In other cases, when you have a disability condition that’s expected to improve over time and you’ve had that rating for less than five years, the VA can reevaluate your disability condition within 2 to 5 years of your initial examination. Five years with no improvement is a reasonable timeframe indicating that the disability caused by the condition is permanent.
How To Protect Your Disability Rating Before 5 Years Have Passed
The VA needs to establish substantial evidence of a change in your condition before any change will occur in your disability rating. Although this puts the burden of proof on the VA, you still need to be proactive to protect your rating. Do this by keeping good records, documenting your ongoing conditions, and making sure you are attentive to any VA requests you receive.
You should also continue attending all scheduled medical appointments, taking prescribed medications, and fully complying with the VA physician’s care plan. Be sure to express to your physician how the condition continues to impact your life and ability to work so that these ongoing impacts are medically documented.
Other VA Disability Rules And Ratings
When you file a VA disability claim, you can be approved for the 5-Year, 10-Year, or 20-Year Rule.
The 5-Year Rule is for Veterans honorably discharged from service within the past five years. If you qualify, the VA will automatically grant a service connection for any health condition that is found during a VA medical examination related to your military service, even if there’s no clear evidence of a connection.
The 10-Year Rule is for Veterans honorably discharged more than five years ago but less than ten years ago. To use this rule, you must show that your health condition began or worsened during your active military service.
The 20-Year Rule is for Veterans honorably discharged more than ten years ago. To use this rule, you must show that your health condition began or worsened during active military service. The 20-Year Rule protects a Veteran’s disability rating from being reduced below the lowest rating level received for that disability in the past 20 years.
