Today, we’re going to deep dive the ins and outs of the 55 year old rule for VA disability.
Did you know the VA can always make changes to your VA disability benefits through a reevaluation?
Yep, it’s true.
The VA always reserves the right to conduct a reexamination to determine if your disability has improved, worsened, or stayed the same.
Important: VA Raters must consider whether a veteran’s current disability is static and/or permanent before making a reexamination request.
However, veterans are protected from a rating reduction if they are aged 55 years or older.
What is the 55 Year Rule for VA Disability?
The VA 55 year rule states that 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 at age 55 or older:
Scenario: A Veteran born on March 7, 1963, claims an increase in his service connected PTSD, currently evaluated as 50% disabling. Medical evidence supports an increased evaluation of 70%, 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% must be awarded and deemed “static,” with no future review examination scheduled.
Why? Under normal circumstances a Routine Future Examination (RFE) would be scheduled for performance in February 2020, three calendar years following the rating decision. 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 shall not schedule a future examination.
Am I Protected From a VA Rating Reducation at Age 55?
Yes, you are protected from a VA rating reduction if you are 55 years or older.
Why?
Because the VA 55 year rule means that veterans are “protected” from VA rating reductions if they are over the age of 55.
Pro Tip: Note there are 3 important exceptions to the VA disability 55 year rule:
- Fraud: The original rating can be eliminated after 10 years if the VA determines that the original disability rating was based on fraud.
- Permanent and Total VA Ratings: Veterans who have been granted a Permanent and Total (P&T) Rating are exempt from the VA disability 10 year rule. The P&T rating signifies that the service-connected disability won’t improve and can’t be eliminated.
- Disability Conditions Not Expected to Improve: Veterans with service-connected disabilities that are deemed permanent and not expected to improve are also exempt from the 55 year old rule. These conditions are typically characterized by their permanent nature, such as the loss of a limb or a chronic, progressive illness.
Can the VA Reevaluate My VA Disability If I Am Age 55 or Older?
The VA Rater will use the following decision tree from M21-1 to determine if/when to re-evaluate a veteran’s VA disability rating at 55 years of age or older:
| If the Veteran is 55 Years or Older… | Then the VA Rater Shall Not… |
|---|---|
| The Veteran will have reached or surpassed age 55 by the time the reexamination is conducted. | Do not schedule the reexamination unless required to do so by specific regulation, or compelled to do so based on unusual circumstances. |
| The expiration of a future examination control (as discussed in M21-1, Part IV, Subpart ii, 1.B) results in referral to the rating activity, and review of the case indicates that the Veteran is currently age 55 or older. | Cancel any examination not required by regulation, or warranted in light of unusual circumstances, and follow guidance as it appears in M21-1, Part IV, Subpart ii, 2.A. |
| Review in connection with an unrelated claim or issue reveals a future examination control for a Veteran who is currently age 55 or older, or will have reached or surpassed age 55 by the time the reexamination is conducted. | Delete or cancel the existing examination control provided it is not required by regulation, or warranted in light of unusual circumstances, and follow guidance as it appears in M21-1, Part IV, Subpart ii, 1.A.1.j. |
What Types of VA Ratings are Protected?
There are 7 types of protected VA disability ratings not subject to a re-evaluation:
- The disability is “Static,” without material improvement for 5 years or more.
- The disability is “Permanent” and there is no likelihood of improvement.
- The disability has been in place for 10 years or more. Note: Your VA 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 re-evaluation resulted in a reduced evaluation for one or more disabilities.
About the Author
Brian Reese
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).
