Hi veterans, Brian Reese here, and in this post, I’m going to deep-dive the 7 types of “Protected VA Disability Ratings,” to include when you could get a reexamination and reduction of an existing disability rating.
I’ll also explain key concepts behind Routine Future Examinations (RFEs), VA protected ratings, and principles of VA rating reductions.
Okay, let’s jump into the different types of protected VA ratings under the law.
- What Are Protected VA Disability Ratings?
- VA Protected Ratings: What Protections Exist Against VA Rating Reductions?
- What Should I Do If I Get a Proposed VA Rating Reduction?
- What Is a Static Disability?
- What Is a Permanent Disability?
- VA Reexaminations Decision Tree Used by VA Raters
- Protected VA Disability Ratings – Frequently Asked Questions (FAQs)
- How often does the VA reevaluate ratings?
- What is the VA 5 year rule?
- What is the VA 10 year rule?
- What is the VA 20 year rule?
- How does the 5 10 20 year rule for VA disability compensation work?
- What is the VA 55 year old rule?
- What is the VA 100% Rule?
- How to tell if your VA disability is permanent on eBenefits?
- Can the VA reduce a Permanent and Total rating?
- Can the VA reduce my PTSD rating?
- Will I lose my VA disability if I get a job?
- About the Author
What Are Protected VA Disability Ratings?
Generally, there are 7 categories of protected VA disability ratings:
- The disability is “Static,” without material improvement for 5 years or more
- The disability is “Permanent” in character and of such nature that there is no likelihood of improvement
- The disability has been in place for 10 years or more. *Note: The rating can still be reduced (not eliminated) if medical evidence shows that the disability has improved.
- The disability has been continuously in effect for 20 years or more
- The veteran is over 55 years of age (except under unusual circumstances or where required by regulation)
- The veteran has a 100% VA rating that’s deemed a “total” disability. *Note: The VA can only reduce the rating if the medical evidence demonstrates “material improvement.”
- The disability is rated at the prescribed schedular minimum within its Diagnostic Code (DC)
- The disability is rated at 10% or less, OR
- The combined evaluation would not change even if the VA reevaluation resulted in a reduced evaluation for one or more disabilities.
VA Protected Ratings: What Protections Exist Against VA Rating Reductions?
- A proposed VA rating reduction, and any final VA rating decision, shall be based on a comprehensive review of the veteran’s entire medical record (e.g., it can’t just be the opinion of a single C&P examiner)
- The VA must prove there has been “material improvement” in the disability since the last VA rating decision
- The VA must conduct a thorough C&P examination that’s adequate for rating purposes, as required in 38 CFR 4.2 and 38 CFR 4.10, AND
- The evidentiary record reflects an improvement in the veteran’s ability to function under the ordinary conditions of life, including employment
The key concept VA Raters consider when making a VA reevaluation request (or VA rating reduction) is whether your current disability condition is considered “Static” and/or “Permanent.”
The key concept VA Raters consider when making a VA rating reduction is whether the medical evidence shows there has been “material improvement” over time.
Pro Tip: In all cases, the VA may NOT reduce an existing VA rating unless medical evidence (in the entirety of the record) shows “material improvement” over time.
What Should I Do If I Get a Proposed VA Rating Reduction?
If the VA proposes to reduce an existing VA disability rating, the veteran has 60 calendar days to respond.
If you disagree with the proposed reduction, you must provide the VA with medical evidence showing that the disability has NOT improved.
You can get your treating physician to write a letter on your behalf, upload specific sections of medical evidence that shows your condition has not improved, or upload any other medical reports or evidence to prove your disability has not gotten better.
What Is a Static Disability?
A static disability is a disability that is considered “permanent” by its nature, history, and severity.
A disability that’s “static” is assigned a permanent evaluation without the need for Routine Future Examinations (RFEs) to determine whether it has improved.
Pro Tip: A static disability is one category of protected VA disability ratings.
What Is a Permanent Disability?
A permanent disability exists when it is reasonably certain, based upon medical evidence, that the level of impairment will continue for the rest of the veteran’s life.
Translation: Your disability is unlikely to show material improvement over time.
Pro Tip: The disability will be assigned a “permanent” evaluation WITHOUT the need for Routine Future Examinations (RFEs).
When deciding if a disability is “Static,” VA Raters shall only order a future examination if there is objective evidence stating clearly a disability is likely to improve.
The principles expressed above apply equally to:
- Initial routine future examinations and,
- Reexaminations requested in the interest of substantiating sustained improvement.
Therefore, where one or more of the above criteria are applicable, and the evidentiary record includes a single examination report (or alternative form of medical evidence) portraying improvement in a disability that has persisted at its assigned level of evaluation for five years or longer, do not proceed with scheduling an additional reexamination unless doing so is:
- Required by regulation, OR
- Warranted in light of unusual circumstances, such as in cases of Veterans over age 55.
VA Reexaminations Decision Tree Used by VA Raters
|If the case necessitates a(n) …||Then, at the time of the rating decision’s preparation, schedule the examination to be conducted …|
|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.|
Protected VA Disability Ratings – Frequently Asked Questions (FAQs)
How often does the VA reevaluate ratings?
If you have a disability condition that’s expected to improve over time, such as a mental health condition that’s had a rating for less than 5 years, the VA can reevaluate your disability condition within 2 to 5 years of your initial examination.
Keep in-mind VA reevaluations aren’t necessarily bad.
For example, the VA is trying to determine if your disability rating should be increased, decreased, or kept the same based upon your Frequency, Severity, and Duration of symptoms.
The VA may also reexamine your VA disability rating if there’s obvious evidence that your condition has improved or even disappeared.
What is the VA 5 year rule?
The VA 5 year rule allows the VA to reevaluate your existing VA disability rating within 5 years of your initial examination, if and only if, your disability condition is expected to show material improvement over time.
However, the VA may still reevaluate your disability rating past the 5 year deadline if your condition has significantly improved, as shown by medical evidence.
What is the VA 10 year rule?
The VA 10 year rule means the VA cannot eliminate a rating that’s been in place for 10 years or more.
However, the rating can be reduced if medical evidence shows that the disability has improved.
There is always an exception to this rule if the VA determines that the original disability rating was based on fraud.
What is the VA 20 year rule?
Again, the only exception to this rule is if the VA can prove fraud.
How does the 5 10 20 year rule for VA disability compensation work?
Certain VA ratings are “protected” based on the 5 10 20 year rule, and not subject to reevaluations or VA rating reductions.
However, any VA rating can be eliminated or reduced if based on fraud.
VA 5 Year Rule: The VA 5 year rule allows the VA to reevaluate your existing VA disability rating within 5 years of your initial examination, if and only if, your disability condition is expected to show material improvement over time.
VA 10 Year Rule: The VA 10 year rule means the VA cannot eliminate a rating that’s been in place for 10 years or more. Note: The rating can still be reduced (not eliminated) if medical evidence shows that the disability has improved.
VA 20 Year Rule: The VA 20 year rule means if your 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.
What is the VA 55 year old rule?
Veterans are protected from rating reductions if they are over the age of 55.
Here’s an example of how a veteran is “protected” from a VA reevaluation for PTSD:
Scenario: A Veteran born on March 7, 1963, claims an increase in his SC posttraumatic stress disorder, currently evaluated as 50-percent disabling. Medical evidence amassed in connection with the claim supports an increased evaluation of 70 percent, but also indicates that the Veteran recently began attending weekly counseling sessions with a therapist, and that the prognosis for progress is hopeful and the potential for improvement likely. The claim is forwarded to the rating activity for a decision in February 2017.
Result: The increased PTSD rating of 70 percent must be awarded and deemed “static,” with no future review examination scheduled.
Why? Under normal circumstances a routine future examination would be scheduled for performance in February 2020, three years following the rating decision’s preparation. However, the Veteran, though only 54 years old at the time of the claim’s referral to the rating activity, will have surpassed age 55 by the time the examination is conducted. Thus, do not schedule a future examination.
What is the VA 100% Rule?
If a veteran has a 100% VA disability rating, that’s deemed a “total” disability, the VA can only reduce the rating if the medical evidence demonstrates “material improvement” in the disability condition.
How to tell if your VA disability is permanent on eBenefits?
Login to eBenefits, click “Manage” then “Documents and Records” and then “VA Letters.”
Note the feature recently moved to VA.gov so you’ll be prompted to login there.
Once logged in, click “Get Your VA Benefit Letters.”
Confirm your mailing address and then click “View Letters.”
Scroll down to “Benefit Summary and Service Verification Letter.”
Under “VA benefit and disability information” you’ll see multiple categories that are either checked or unchecked.
If your VA disability is permanent, the box will be checked next to: You are considered to be totally and permanently disabled solely due to your service-connected disabilities.
Can the VA reduce a Permanent and Total rating?
No, the VA cannot reduce a Permanent and Total VA rating unless the original disability rating was based on fraud.
The major benefit of being deemed both “Permanent and Total” or 100% P&T is that your VA rating is protected from a future rating reduction.
This means the VA can NEVER reduce your rating!
Can the VA reduce my PTSD rating?
Yes, the VA can reduce your PTSD rating if medical evidence demonstrates material improvement over time.
However, the VA cannot arbitrarily reduce your VA rating for PTSD without following the reevaluation procedures outlined above.
Will I lose my VA disability if I get a job?
No! The VA wants you to work, if possible.
The only time work and income level factors into VA disability is if you’re receiving VA Unemployability, also known as TDIU—income limits do apply.
In addition, VA pension benefits are based on income level and net worth limits whereas VA disability compensation benefits are based on level of disability (aka, “Severity of Symptoms”).
Income and not worth are NOT factors in determining VA disability compensation benefits to eligible veterans.
For example, you can be 100% P&T and still have a great job that pays you well.
About the Author
Brian Reese is one of the top VA disability benefits experts in the world and bestselling author of You Deserve It: The Definitive Guide to Getting the Veteran Benefits You’ve Earned (Second Edition).
Brian’s frustration with the VA claim process led him to create VA Claims Insider, which provides disabled veterans with tips, strategies, and lessons learned to win their VA disability compensation claim, faster, even if they’ve already filed, been denied, gave up, or don’t know where to start.
As the founder of VA Claims Insider and CEO of Military Disability Made Easy, he has helped serve more than 10 million military members and veterans since 2013 through free online educational resources.
He is a former active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy, Colorado Springs, CO, and he holds an MBA from Oklahoma State University’s Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class).