If you are a veteran with a service-connected disability, you may be eligible for disability compensation from the Department of Veterans Affairs (VA). Once your disability has been rated by the VA, you will receive monthly payments based on the severity of your condition. However, it’s important to understand that the VA can reevaluate your disability rating at any time. This process is governed by the VA Disability 5 Year Rule.
WHAT IS THE VA DISABILITY 5 YEAR RULE?
Under the VA Disability 5 Year Rule, the VA may reevaluate your disability rating at any time, but they must wait for at least five years from the date of your initial rating decision. However, there are exceptions to this rule. During the initial five-year period, the VA may review and reevaluate your VA disability rating only if there is an expectation that your disability condition will improve over time. VA Raters follow specific principles when requesting a reevaluation, such as assessing whether your VA disability is “Static” or “Permanent.” Moreover, even after the five-year deadline, the VA may still conduct a reevaluation if there is medical evidence indicating significant improvement in your condition.
HOW IS A STATIC DISABILITY DEFINED AND EVALUATED BY THE VA?
A static disability is one that is deemed to be permanent based on its nature, history, and severity, and does not require any future evaluations to assess whether it has improved or worsened.
WHAT IS A PERMANENT DISABILITY?
A permanent disability is a type of disability that is expected to continue for the remainder of the veteran’s life. Medical evidence is used to determine the extent of the impairment and the likelihood that it will improve over time. If it is determined that the disability is unlikely to improve, it will be given a permanent evaluation and future examinations will not be required.
HOW DOES THE VA DETERMINE WHETHER TO REEVALUATE A DISABILITY RATING?
The VA uses a number of factors to determine whether to reevaluate a disability rating. These factors include:
- Changes in the severity of your condition
- New medical evidence or information about your condition
- The age of your disability rating
- The likelihood that your condition has improved
- The likelihood that your condition has worsened
- If the VA decides to reevaluate your disability rating, they will send you a notice in the mail explaining why they are doing so. This notice will also include information about the reevaluation process and what you can do if you disagree with the decision.
CAN THE VA TAKE AWAY 100% PERMANENT AND TOTAL DISABILITY?
Yes, the VA (Department of Veterans Affairs) can take away a 100% Permanent and Total (P&T) disability rating, but it is not a common occurrence and is subject to specific circumstances.
If the VA determines that the veteran’s condition has improved, or if there was an error or fraud in the original rating decision, then the rating may be reduced or terminated. However, veterans who have been receiving 100% P&T disability benefits for 20 years or more are typically protected from rating reductions, except in cases of fraud.
It’s worth noting that the VA has a responsibility to conduct periodic reevaluations of a veteran’s disability status to ensure the appropriate level of compensation is being provided. However, these reevaluations are generally less frequent for those with a 100% P&T rating.
WHY DOES THE VA RE-EVALUATE DISABILITY RATINGS?
The VA re-evaluate disability ratings to ensure that veterans are receiving the appropriate level of compensation for their service-connected disabilities. If your condition has improved, the VA may decrease your disability rating and reduce your monthly payments. On the other hand, if your condition has worsened, the VA may increase your disability rating and provide you with higher monthly payments
Officials use a matrix to guide their decisions on when to schedule these examinations.
VA Raters are required to exercise good judgment and consider guidelines such as 38 CFR 3.327(b) to determine if future examinations are needed. The policy of the Veteran Benefits Administration (VBA) is to request future examinations only when necessary and to limit cases where they are required.
A RATING OFFICIALS USE THE VA REEXAMINATION DECISION MATRIX
|Case Necessitates||Examination Schedule|
|Routine Future Examination (RFE) to monitor for anticipated improvement in a service connected disability.||In 3 years.|
|Reexamination to monitor for evidence of sustained improvement in a stabilized service connected disability that is shown to have improved.||In 18, 24, or 30 months, depending upon the facts and circumstances of the individual case.|
|Examination to facilitate the reevaluation of a prestabilization rating prepared under the authority of 38 CFR 4.28||No earlier than 6 months, nor later than 12 months, following discharge from service.|
|Examination to evaluate a service connected mental disorder that was: Incurred by reason of traumatic stress, and Rated in accordance with the provisions of 38 CFR 4.129||Within the six-month period following the Veteran’s discharge.|
|Examination to evaluate post-therapeutic residuals of service connected malignancy (cancer).||Six months following cessation of surgical, x-ray, antineoplastic chemotherapy, or other therapeutic procedure. Exceptions: For SC bone malignancy evaluated under 38 CFR 4.71a, DC 5012, any needed examination must be scheduled one year following cessation of treatment. For service connected malignancy of the brain or spinal cord evaluated under 38 CFR 4.124a, DCs 8002 or 8021, respectively, any needed examination must be scheduled two years following cessation of treatment. Concede the disability evaluation’s permanence and schedule no future examinations if the considerations discussed in M21-1, Part III, Subpart iv, 5.B.3.a are applicable.|
|Mandatory examination/reexamination in connection with a specific diagnosis code.||At a time or interval consistent with the applicable regulation’s requirements.|
WHAT ARE THE EXCEPTIONS TO THE VA DISABILITY 5 YEAR RULE?
There are several exceptions to the VA Disability 5 Year Rule. The most common exceptions include:
A substantial increase in the severity of your condition:
- The discovery of fraud or misconduct related to your disability claim
- A clear and unmistakable error (CUE) in the initial rating decision
- If any of these exceptions apply to your case, the VA can reevaluate your disability rating at any time, regardless of when your initial rating decision was made.
WHEN ARE YOU SUBJECT TO A VA REEVALUATION?
As per M21-1, the Adjudication Procedures Manual of the VA, VA Raters are instructed not to schedule a Routine Future Examination (RFE) if certain conditions are met. These include if the disability is “Static” and has not materially improved over five years, if the disability is “Permanent” and not likely to improve, if the Veteran is over 55 years of age (unless required by regulation or unusual circumstances), if the evaluation is the prescribed minimum, if the evaluation is 10% or less, or if the combined evaluation would not change even with a reduced evaluation.
If a disability is deemed “Static,” VA Raters should only schedule a future examination if there is clear objective evidence indicating potential improvement.
These principles apply to both Initial Routine Future Examinations (RFEs) and Reexaminations requested to verify “sustained improvement.” If the above conditions are met and there is evidence of sustained improvement in a disability that has been evaluated for five years or more, an additional reexamination should not be scheduled unless required by regulation or warranted by unusual circumstances, such as in cases of Veterans over age 55.
WHAT CAN I DO IF I DISAGREE WITH A DISABILITY RATING DECISION?
If you disagree with a disability rating decision made by the VA, you have the right to appeal the decision. The appeals process can be complicated, so it’s important to seek assistance from a veterans service organization (VSO) or an attorney who specializes in veterans law.
In conclusion, understanding the VA Disability 5 Year Rule is crucial for veterans who receive disability compensation from the VA. While the VA can reevaluate your disability rating at any time, they must wait at least five years from the date of your initial rating decision. By staying informed about the reevaluation process and your rights as a veteran, you can ensure that you receive the appropriate level of compensation for your service-connected disabilities.
WHAT ARE THE VA RATING RULES?
The VA rating rules are a set of guidelines that determine when and how the VA can reevaluate and adjust a veteran’s disability rating.
WHAT IS THE 10-YEAR RULE FOR VA DISABILITY?
The 10-year rule for VA disability means that the VA cannot eliminate a rating that’s been in place for 10 years or more, but it can be reduced if there’s evidence of improvement. However, the VA can still eliminate the rating if it was based on fraud.
WHAT IS THE 20-YEAR RULE FOR VA DISABILITY?
The 20-year rule for VA disability means that if a veteran’s rating has been in effect for 20 years or more, the VA cannot reduce it below the lowest rating it has held for the previous 20 years, except in cases of fraud.
HOW DO THE 5, 10, 20 YEAR RULES WORK FOR VA DISABILITY?
The 5 10 20 year rules for VA disability protect certain ratings from reevaluation or reductions. However, any rating can still be adjusted if the VA determines it was based on fraud.
HOW DOES THE VA 55-YEAR-OLD RULE WORK?
Under the VA 55-year-old rule, veterans over the age of 55 are protected from rating reductions. For instance, if a veteran is rated at 70% for PTSD and the medical evidence shows potential for improvement, the VA cannot reduce their rating, even if they should undergo a future review examination.
WHAT DOES THE TERM “VA 100 PERCENT RULE” MEAN?
Under the VA 100 percent rule, if a veteran has a 100% VA disability rating, the rating is considered “total” disability, and the VA can only reduce the rating if there is medical evidence demonstrating material improvement in the disability condition.
CAN THE VA REDUCE A PERMANENT AND TOTAL RATING?
No, the VA cannot reduce a Permanent and Total rating unless the rating was initially based on fraud. This rating is protected from future rating reduction.
CAN THE VA REDUCE MY PTSD RATING?
Yes, the VA can reduce a PTSD rating if there is medical evidence demonstrating material improvement over time. However, the VA cannot arbitrarily reduce the rating without following the reevaluation procedures outlined above.
WILL I LOSE MY VA DISABILITY IF I GET A JOB?
No, the VA encourages veterans to work. Income level and net worth are not factors in determining VA disability compensation benefits. However, income limits do apply for VA Unemployability or TDIU benefits. VA pension benefits are based on income level and net worth limits, not the severity of symptoms.