VA Disability 5 Year Rule Explained

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In this post, I’m going to deep-dive into the “VA Disability 5 Year Rule” to include when you might be subjected to a VA reevaluation of an existing disability rating.

I’ll also mythbust the Why, How, What, and When behind Routine Future Examination (RFE) timelines and VA rating reductions.

So, “When Can the VA Reevaluate My Disability Rating?“

Let’s take a look.

Generally, the VA disability 5 year rule means the VA can 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 substantially improved, as shown by medical evidence.

The key principles VA Raters consider when making a VA reevaluation request is whether your current VA disability condition is considered “Static” and/or “Permanent.”

What is a Static Disability?

A static disability is a disability that is considered “permanent” by its nature, history, and severity.

It is assigned a permanent evaluation without the need for future examinations to determine whether or not the disability has improved.

What is a Permanent Disability?

A permanent disability exists when it is reasonably certain, based on 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.

In this instance, the disability will be assigned a permanent evaluation WITHOUT the need for future examinations.

VA Raters are required to exercise prudent judgment and refer to 38 CFR 3.327(b) in determining the need for review disability examinations. 

For example, it is the policy of the Veteran Benefits Administration (VBA) to request future examinations only when absolutely necessary, and every effort should be made to limit cases where future examinations are requested.

When are You Subject to a VA Reevaluation?

According to M21-1, the VA’s Adjudication Procedures Manual, VA Raters shall NOT schedule a Routine Future Examination (RFE) when:

• The disability is “Static,” without material improvement over five years,
• The disability is “Permanent” in character and of such nature that there is no likelihood of improvement,
• The Veteran is over 55 years of age (except under unusual circumstances or where required by regulation),
• The evaluation is the prescribed schedular minimum within its diagnostic code,
• The evaluation is 10 percent or less, OR
• The combined evaluation would not change even if the VA reevaluation resulted in a reduced evaluation for one or more disabilities.

Expert Tip: 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 (RFEs) 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 5 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.

What is the VA Disability 5 Year Rule for Requesting Reexaminations?

The VA disability 5 year rule allows the VA to reevaluate an 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, although this is uncommon.

VA Reexamination Decision Matrix Used by VA Rating Officials

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.

When Can the VA Reevaluate My VA Disability Ratings?

Facing a VA disability rating reexamination can be extremely stressful.

Keep in mind, however, that VA reevaluations aren’t necessarily a bad thing.

For example, the VA is trying to determine if your disability rating should be increased, decreased, or kept the same based on the Frequency, Severity, and Duration of symptoms.

In general, 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–this is quite common.

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?

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.

Again, the only exception to this rule is if the VA can prove fraud.

How Does the 5 10 20 Year Rule VA Disability Work?

Certain VA disability ratings are “protected” based on the 5 10 20 year rule, and are not subject to reevaluations or rating reductions.

However, any VA rating can be eliminated or reduced if based on fraud.

VA 5 Year Rule Explained:

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 Explained:

The VA 10 year rule means the VA cannot eliminate a rating that’s been in place for 10 years or more. The rating can still be reduced (not eliminated) if medical evidence shows that the disability has improved.

VA 20 Year Rule Explained:

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 a VA PTSD increase from 50 to 70, which is currently rated at 50%.  Medical evidence amassed in connection with the claim supports an increased evaluation to 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 70 percent VA rating for PTSD 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, the VA Rater should NOT schedule a future examination.

What is the VA 100 Percent 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.

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 your job and income level factor 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.

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