VA Disability 5-Year Rule

Category: Veterans Disability Law

Article by Daniel J. Tuley

If the U.S. Department of Veterans Affairs (VA) believes your disability status has changed, they may request a VA disability rating reassessment. This usually happens when a doctor’s note indicates a change in your health, and the VA asks for a reevaluation to review the impact of those changes on your disability. Under the VA disability 5-year rule,  if five years have passed since your initial disability and there has been no reevaluation, your rating may be considered stabilized, offering you some protection from having your status changed and benefits reduced in the future. 

This article covers everything you need to know about the VA disability 5-year rule and where to go for help if you’re concerned about an upcoming reevaluation. 

What is the VA Disability 5-Year Rule?

The VA disability 5-year rule protects veterans by making it more difficult for the VA to change your disability status and reduce your benefits after your rating has been effective for five years. The 5-year rule exists because five years is viewed as an adequate time frame to determine whether someone’s condition is permanent.

Disability Evaluations and the VA 5-Year Rule

During your initial compensation and pension exam, you received a disability rating which dictates whether you can be asked for a VA disability reassessment and rating review. To avoid wasting resources, the VA won’t reevaluate conditions with unchanging limitations, such as amputation. This decision not to reevaluate indefinitely will be noted in your disability rating and paperwork.

However, suppose your health is expected to improve over time. In that case, the VA will likely reevaluate you within two to five years of your initial evaluation.  For service-connected mental health disabilities or other potentially temporary disabilities, it can be challenging to know the permanency of a condition and its impact long term with just one evaluation. They will reevaluate you if they have reason to believe there are changes. 

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The VA 5-year rule protects veterans from unfair reductions in benefits by transitioning the veteran to a stabilized rating status after five years of stable conditions. At this point, the veteran will no longer be subject to routine reevaluations. The VA can still reduce the rating if the condition shows sustained improvement over time. Sustained improvement must be shown through a VA claim exam, with adequate supporting evidence. 

When can the VA request a reevaluation after 5 years?

For veterans with a long-term disability, if your condition shows significant and sustained improvement, you may be asked for a reevaluation to determine the extent you are still impaired. The VA will request a reevaluation to review your health changes, assess the severity of your disability, and determine if your disability rating is still accurate.

Important note: A VA disability reevaluation increase in compensation is always a possible outcome of a reevaluation. If the finding is that your condition has worsened, you may be eligible for a VA disability increase rather than a decrease. This increase in rating can result in additional benefits being granted. 

Reevaluation Protections

 Several protections are offered to veterans dictating when a disability reassessment is unnecessary and should not be required. According to the VA’s Adjudication Procedures Manual (M21-1), VA raters should not schedule a routine VA disability rating review when one of the following conditions are met:

• The disability is permanent, and there is no likelihood of improvement
• The disability is deemed static after five years without improvement
• The veteran is over 55 years of age unless under unusual circumstances or required by regulation
• The evaluation is the prescribed schedular minimum within its diagnostic code
• The first evaluation resulted in a rating of 10 percent or less
• The combined evaluation would not change even if the VA reevaluation resulted in a reduced evaluation for one or more disabilities.

When is the VA 5-year rule effective date?

The 5-year rule effective date is based on the effective date the VA assigns to your disability benefits claim. For example, if you receive approval for benefits from the VA stating March 20, 2023 as your effective date, and you do not receive a request for a reevaluation before March 20, 2028, then you’ve hit the VA’s 5-year mark. 

How to Protect Your Disability Rating in the First Five Years

You can work to protect your disability rating during the initial five-year window by going to all of your medical appointments, taking your medications, and generally following your doctor’s plan of care. Your doctor needs to know how your condition affects your everyday life and your ability to work, so you’ll need to highlight this during your time together. These life impacts need to be well documented in your health history to ensure the full extent of your disability is understood by everyone reviewing your medical records.

Fighting a VA Rating Reduction

Suppose you receive notice that the VA has deemed a rating reduction appropriate. In that case, you have 30 days to request a hearing and 60 days to submit your evidence.  But, if a decision has already been made to lower your rating or terminate your benefits, you have options if your disability still remains. Our experienced disability lawyers can help you navigate a VA appeal and get you the benefits you deserve. They can help you explore the various disability laws and other options available to you. 

 FAQs

Can the VA take away a diagnosis of 100% permanent and total disability?

Yes, a diagnosis of 100% permanent and total disability can be reduced or revoked under some circumstances, including the following:

• If the rating was the result of a fraudulent claim
• If a veteran files a new claim and the VA discovers during the required examination that the condition has improved
• If the permanent and total disability rating was a VA error 

Can the VA reduce a permanent and total rating?

Yes, the VA can reduce your rating if you experience sustained improvement in your disability and it’s documented in your health history.

When are VA disability reassessments most commonly requested?

Reevaluations most commonly occur between years two and five after diagnosis.

Receive Help from VA Disability Attorneys

The VA reassesses disability ratings when they believe a veteran’s health status has changed. Still, they’re not always correct in their decision. The VA disability lawyers at Tuley Law Office in Evansville, Indiana are experts in disability law and can help you navigate the assessment and reassessment processes. Having an experienced VA disability lawyer by your side can help you ensure you receive the benefits you deserve. Call us today for a free consultation at (812) 625-2149 or fill out our online form.

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