The VA 5-year rule pertains to a rating that has been in effect for five years or longer. After a five-year period has passed, the rating is considered a stabilized rating. It protects your disability claim by not allowing the VA to reduce your disability rating unless your condition has significantly improved over time.
American Soldier holding books
Did you know that the United States Department of Veterans Affairs can increase, decrease, or even terminate your VA disability benefits upon re-examination?
The VA has the right to examine you to see if your disability has lessened or even disappeared over time. Since some disabilities are permanent, not every veteran will be re-examined.
Understanding the VA Disability 5 Year Rule
The VA disability 5 year rule allows the VA to examine your VA disability rating within 5 years of your initial examination if your condition is expected to improve over time. The VA may still change your disability rating past the 5-year deadline if your condition has significantly improved. The VA Disability 5 Year Rule is a protective mechanism for a veteran against the VA reducing their disability rating after it has been in place for five years. When five years have passed, it becomes much more difficult for VA to reduce your rating; usually the VA would need to prove that your disability is showing sustained and substantial improvement.
Why does the VA re-examine VA disability ratings?
If five years passes and there is no improvement, the condition is considered Static.
Disability benefits are often granted for permanent conditions. On the other hand, they are also awarded for conditions that are expected to improve with medical treatment and the passage of time. The VA requests reexaminations on conditions that they believe are likely to improve. If there is five years with no improvement, it is safe to deduce that the disability caused by the condition will be permanent. Not all types of service connected disabilities are permanent. The only exceptions to the VA disability 5 year rule are veterans who are protected by a Permanent and Total Rating or anyone else with a condition that’s never expected to improve: an example would be, a veteran with a missing leg. This would be determined to be a permanent service connected disability.
What is a VA Permanent and Total Disability Rating?
A VA rating of permanent and total (P&T) disability is when a condition is rated 100% and isn't expected to improve over time. Veterans with a P&T rating aren't re-evaluated and receive monthly benefits at 100% for the remainder of their lives.
When does the VA re-examine VA disability ratings?
The VA will most likely re-evaluate your condition within 2 to 5 years of your initial examination, if you have a condition that is expected to improve. The VA may also re-examine your VA disability rating if there is obvious evidence that your condition has significantly improved or even disappeared.
Re-examination and Veterans over 55 years old
It is quite rare for the VA to request reexaminations of disabling conditions for individuals who are age 55 and over, with the exception for certain cancers. The VA disability benefits continue at the same level even after a claimant is past the retirement age of 65. The rules of the VA prevents reductions based simply on increased age.
How does the VA re-examine VA disability ratings?
The VA will schedule an examination to determine if your VA disability rating is still appropriate for the magnitude in which your service connected disability affects your ability to function, as well as your quality of life. It is important to note that attending or rescheduling your appointment is critical. If you are absent, the VA will have grounds to reduce or even terminate your VA disability benefits.
After finally receiving your VA disability benefits, you may be concerned that the VA will attempt to reduce your compensation. Fortunately, there are rules in place that may allow you to keep your current disability rating. The VA Disability 5 Year Rule could allow you to maintain your benefits indefinitely. If you have received a reexamination notice from the VA or you are getting close to the five-year mark of when your disability rating was given, a representative from Veterans Claim Servants can help you understand the impact of this rule.
2 – 5 Years Re-examinations
Reexaminations are typically scheduled for the VA to have the opportunity to review the progress of a disability over time, and potentially reduce benefits if the disability has improved. Since the 5 Year Rule, the VA generally attempts to schedule reexaminations for veterans that received their disability rating 2-5 years ago.
When your disability claim is being reevaluated, typically a new Compensation and Pension (C&P) examination is to be completed. Once the C&P examination is complete, if the VA feels that changes to your rating are necessary, they will mail you a proposed reduction. Thereafter, you have 60 days to respond to the letter, providing evidence supporting the need for disability benefits to continue at their current rate. You may request a hearing to appeal the proposed reduction, you must pursue this within 30 days of the date of the letter. Once the 60 day period has passed, if you have not submitted new evidence or requested a hearing, the proposed reduction will typically be finalized. However, any finalized reduction may be appealed.
The Reexamination process can work for you
If you receive a reexamination notice, it does not always mean that your benefits are going to be reduced. In fact, in some cases, the reexamination process has revealed a worsening of a veteran’s condition and ultimately resulted in the veteran seeing an increase in their disability rating.
What can I do to safe guard my disability rating before 5 years passes?
During the initial five-year period after obtaining a disability rating, a veteran can protect their rating by continuing to attend all scheduled medical appointments, taking prescribed medications, and complying with their physician’s care plan. They should also be sure to express to their physician how the condition continues to impact their life and ability to work so that these ongoing impacts are medically documented. Please note: the VA generally only requests a reexamination after five years have passed if they have material evidence that the condition has improved: this evidence is generally reflected in the doctor’s treatment notes.
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