When you are awarded a VA Service-Connected Disability rating, the VA retains the right to reexamine you to determine if your disability is still present and warrants the original rating. In short, it is possible for the VA to increase, reduce, or terminate, disability benefits based on a reexamination. But don’t let this scare you: not every veteran’s disability rating is scheduled for a reexamination, and not every rating will change.
For example, some service-connected disability ratings are considered protected, and will not be changed. Veterans with a P&T Rating (Permanent and Total) will usually not be scheduled for a reexamination. The same thing goes for injuries that are considered permanent or static. These include injuries that will never change, such as a missing limb.
Let’s take a look at VA Reexaminations to better understand the details of why, when, and how, the VA reexamines disability ratings, and whether or not your rating will be reviewed in the future. And if your VA disability rating is reviewed, keep in mind reviews work both ways: they can increase or decrease your rating, depending on supporting evidence and documentation.
Why the VA Reexamines Veterans with a Service-Connected Disability Rating
The why is easy to answer. Not all medical conditions are permanent. Some injuries heal over time, at least to some degree. The VA wants to ensure they are compensating you for your injuries at an appropriate rate. When you are assigned a disability rating, the VA also determines if they will want to reexamine you in the future. This typically only happens for injuries that have a reasonable expectation of improving over time. Reexaminations are usually scheduled within two to five years after the initial examinations, or they can take place any time there is material evidence in your change of condition. You will receive a Reexamination Letter detailing what will take place, and when.
Notice of Reexamination
The VA must send you a reexamination letter before they can change your service-connected disability rating. It’s essential that you attend this appointment, or work to reschedule it for a better time. If you don’t attend the appointment or provide supporting evidence for your case, the VA can reduce or terminate your benefits. The Notice of Reexamination should include contact information where you can reschedule your appointment if necessary.
The VA may send a Notice of Reexamination at pre-scheduled interval (such as the aforementioned two to five years), or when they have material evidence there has been a change in your medical condition. This could be evidence that your situation has improved or disappeared. You have 30 days to request a hearing if you wish to contest the VA decision, and you have up to 60 days to submit evidence that a reduction in your rating is not warranted.
Keep in mind, the VA cannot reduce your service-connected disability rating without first sending you notice. Failure to do so on their end should result in a full reinstatement of your benefits.
When the VA Will Not Schedule You for a Reexamination
The VA will typically not request to reexamine your rating under the following conditions:
- The veteran is over age 55.
- The disability is static (such as a loss of limb).
- The disability is considered permanent and is not expected to improve (e.g. blindness, deafness).
- The disability is already at a minimum rating for that particular disability.
- Reducing an individual rating would not affect the total combined disability rating.
These conditions are significant. The VA will not schedule are reexamination for permanent and static disabilities, so you can safely assume those ratings will remain the same. Age 55 is significant because it represents an age at which the VA assumes the veteran is too old to reasonably reenter the workforce (keep in mind VA disability ratings represent your ability to perform work at the level you were able to before you had the injury while you were serving in the military).
Finally, the VA will not look to reduce your VA disability rating when reducing one rating wouldn’t have a material impact on your overall disability rating. This applies to veterans with multiple medical conditions and disability ratings.
If you have been contacted by the VA to have your case reexamined and you meet any of the above criteria, then contact them with the phone number listed on your Notice of Reexamination and explain why you do not believe you should be reexamined. You may be able to have the reexamination canceled. The VA will not usually be able to reduce your disability rating without a reexamination, so your rating should be safe if you meet any of the above criteria.
Protected VA Disability Ratings
Certain VA disability benefits are considered Protected Ratings, according to the VA (though others say the term “protected” is a misnomer). This is where it helps to be able to find and read the appropriate regulations, or find an expert who can help you through the task. Here is a document that quotes some of the ratings protections for the 10 and 20 year rules (Word doc on VA site).
- 5 year rule: If the rating has been in effect for 5 years, it cannot be reduced unless your condition has improved on a sustained basis (The VA must have documentation supporting this is a permanent improvement).
- 10 year rule: A service connected disability rating cannot be terminated if it has been in effect for 10 years. Compensation can be reduced if evidence exists that the condition has improved. The sole exception is if the VA can prove fraud, in which case the VA can terminate the benefits.
- 20 year rule: If the rating has been in effect for 20 years, it cannot be reduced below the lowest rating it has held for the previous 20 years. The only exception is if the VA can prove fraud.
- 100% rule: The VA must prove your medical situation has materially improved and as a result, you are able to perform substantial work.
What do these protected ratings mean? Basically, if you have had a VA service-connected disability rating for 5 years or more, the VA must prove your condition has improved on a sustained basis before they can reduce or terminate your disability rating. After 10 years, the VA can only reduce your rating; they cannot terminate it (absent proof of fraud). After 20 years, your rating cannot be reduced below the lowest rating you have held for the last 20 years. These distinctions are important, because some ratings can vary over the years, based on the medical condition.
For example, let’s say you have a knee injury that warrants a 30% disability rating when you complete your initial VA evaluation. After 5 years, the VA cannot reduce this rating below 30% unless they can prove the injury has healed on a sustained basis. If it has improved to the point the injury warrants a lower rating, or the injury no longer exists, the benefit can be reduced or terminated. After 10 years, the benefit can no longer be terminated, but it can be reduced if the VA can document substantial sustained health improvements. After 20 years at that rating, your benefit can no longer be reduced below its lowest rating or terminated (unless there is proof of fraud).
The 100% rule is much more difficult to have decreased. The VA must prove your health has materially improved, and you are now able to perform substantial work. If all of your injuries still leave you unemployable, then it is likely your benefit will not be reduced. Most veterans with a 100% rating have one or more major service-connected medical conditions, and possibly additional multiple less-severe injuries. The VA must prove the veteran is able to perform substantial work even with this assortment of medical conditions.
Reducing Your Disability Rating – VA Must Prove Change in Condition
The VA needs to establish substantial evidence of a change in condition before any change can occur to your service-connected disability rating. This puts the onus of the work on them. But you still need to be proactive to protect your rating. If the VA sends you a Notice of Reexamination, you need to show up for your scheduled appointment, or reschedule it, if possible. If you miss your scheduled appointment, the VA can reduce or terminate your rating without additional warning. Reestablishing your rating could take some time, or may be impossible, barring a legitimate reason for missing the appointment.
You can also request a hearing if the VA wishes to reduce your rating. You may find it helpful to enlist the help of a lawyer or your own medical professionals. You will want to ensure you have sufficient documentation to support your claims – whether you believe the rating should remain the same, or if it should be increased.
A Reexamination is Not the End of the World
A Notice of Reexamination can actually result in an increased disability rating if the situation warrants it. The VA will not go out of their way to increase your benefits rating for you. However, if the situation is warranted by your examination, then they will increase your disability rating. Keep this in mind if you are scheduled for a reexamination. It’s also important to understand that requesting an increase in disability ratings can result in a decrease if the VA can prove your medical condition has improved over time.
Bottom line: A VA disability rating is not always a static rating that will remain unchanged over the course of your lifetime. Your rating may remain unchanged, but it could also increase or decrease, depending on circumstances. If you feel there is a problem with your rating, it is best to find someone who specializes in VA disability claims and see if you can get them to help you with your claim.