The U.S. Department of Veterans Affairs uses a rating system to determine the appropriate level of disability benefits for each eligible veteran based on how much their service-connected condition interferes with their ability to function. However, because a disabling condition can change over time, the VA reserves the right to reevaluate a veteran’s rating. This review may cause an increase or decrease in benefits, depending on what’s changed.
However, under the VA disability 5-year rule, a veteran has extra protections that make it more difficult for the VA to reduce a disability rating. The trusted veterans disability attorneys at Rob Levine Law can advise veterans about their rights under this rule and help them pursue the benefits they deserve.
What Is the VA Disability 5-Year Rule?
The VA disability 5-year rule, outlined in 38 C.F.R. § 3.344, provides important protections for veterans whose disability ratings have been in place for five years or more. This rule prevents the VA from reducing a veteran’s rating without clear and convincing evidence that the veteran’s condition has improved under normal living conditions.
Once a disability rating has been in effect for at least five years, it is considered stabilized. This means the VA can’t reduce the rating unless it can prove, based on reliable medical evidence, that the veteran’s condition has improved in a way that is sustained and permanent. The VA must demonstrate that the improvement is not likely to revert or fluctuate.
The 5-year rule is an essential safeguard for veterans, providing peace of mind that their benefits won’t be reduced without a thorough examination of their medical history and an assurance that their condition has truly stabilized. However, the rule does not prevent the VA from reevaluating a disability. The VA may request an exam if there is reason to believe a condition has materially changed, but it cannot lower the rating based on an exam alone unless it meets the legal criteria under 38 C.F.R. § 3.344.
This protection ensures that veterans’ ratings remain consistent unless there is solid proof that their condition has improved in a significant and lasting way. If your disability rating has been stable for five years or more, the VA is required to meet a higher burden of proof before it can reduce your benefits.
What Are Protected VA Disability Ratings?
A protected VA disability rating reflects a condition that has remained stable over time, which means the VA cannot change it without cause. The 5-year rule is one type of protection because the VA cannot request a review or reduce benefits without medical evidence.
Other protections include the following:
- The 10-year rule: The VA cannot nullify a service connection for a disability without evidence of fraud or official records disqualifying the connection
- The 20-year rule: The VA cannot reduce a disability that has had the same rating continuously for 20 or more years without evidence of fraud.
- Permanent and total disability: This status indicates that the veteran’s disability will likely not improve over time. The VA cannot reduce this rating without proof of improvement, which is rare in such cases.
There are select exceptions to protected ratings. For example, the VA grants a 100 percent disability rating while cancer is active and for six months thereafter. If your cancer goes into remission, the VA will typically schedule a reevaluation, even if other protections apply.
The rules surrounding VA disability ratings and protections are complex and challenging to navigate. If you have questions about VA claims or ratings, consult an experienced veterans disability attorney.
How Can VA Disability Ratings Change Over Time?
Disability ratings may change if the associated service-connected disability improves or worsens. For example, chronic pain conditions often have fluctuating severity that may be moderate for months to years, only to flare or intensify later. Many patients with chronic pain also develop new or worsening depression, which may increase a veteran’s disability level.
Conversely, some conditions improve over time, allowing the veteran to do more and rely less on support. A severe musculoskeletal injury can partially or fully heal following surgery and physical therapy, and prosthesis and occupational therapy help veterans with lost limbs to become more self-reliant. PTSD and depression can also improve with treatment and medication.
The VA reevaluates disabling conditions to ensure each veteran receives fair compensation while preventing unfair changes. If the VA determines a need to raise or reduce benefits, reevaluation documents support the decision.
How Does the VA Disability 5-Year Rule Help Veterans?
The 5-year rule gives veterans peace of mind that their ratings will remain unchanged, allowing them to rely on continued benefits and avoid the hassle of undergoing additional evaluations.
The 5-year rule also provides an extra safeguard if a veteran’s disability rating does not match their impairment levels. Inaccurate ratings happen, but without reevaluation, there is little chance the rating will be reduced.
The VA’s reevaluation policy is to schedule examinations between two and five years after an initial rating. When reevaluation shows a different picture, the VA typically schedules another evaluation no less than five years later. If that examination shows stability, the veteran will receive protection for their updated, accurate rating.
Once a veteran has that five-year protection, they keep it unless their medical status changes. This safeguards the veteran from unexpected benefit changes and reduces the associated stress.
Protections exist for your benefit, but errors and injustices can happen. If you suspect an inaccurate rating or protection violation, talk to a veterans disability attorney. You also might be eligible to file a claim for a ratings increase.
How Can Veterans Keep and Improve Their VA Disability Rating?
Securing a VA disability rating can take time. The claims or appeals process can extend the process even more, sometimes by over a year.
What You Can Do
It’s important to protect your rights by actively managing your condition and monitoring your benefits by doing the following:
- Attend all scheduled medical appointments and exams: Demonstrate that you have done everything your doctor recommends to treat or manage your condition. Keep bills, invoices, or co-pay records showing that you have attended.
- Report any worsening of your condition: The VA encourages veterans to report any worsening of your condition. You may be able to file a claim for an increased disability rating, entitling you to greater benefits.
- Stay in touch with the VA: Make sure they have your correct contact information to avoid missing important notifications, such as notices of changes to your benefits.
- Check your rating regularly: The VA may reduce your benefits if your health has markedly improved. This can happen if your records show a likelihood of partial or total recovery.
The VA makes decisions based on official medical records, but paperwork does not always reflect the reality of your health. A condition may continue to limit your life and cause you pain, even if it has improved.
How a Veterans Disability Lawyer Can Help
If you believe your VA rating does not reflect the extent of your disability, get legal help. Veterans disability lawyers are available to help you file claims, gather evidence supporting your case, and present your situation to the authorities at the VA.
Contact a VA Disability Lawyer Today for a Free Consultation
The VA disability 5-year rule is just one of the protections the VA offers for disability benefits. At Rob Levine Law, we draw on over 25 years of experience to aggressively pursue justice and help you claim the benefits you deserve. We’re here to answer your questions and stand up for you throughout the claims process.
Call (800) 742-3920 or contact us online to schedule your free consultation today. We only get paid if you win—it’s our Fee Free Guarantee®!
