Can the VA Reduce Your Disability Benefits? What You Need to Know About a Reexamination Notice

Did you know that it’s possible for the Department of Veteran Affairs to reduce your VA disability rating? When the VA gives you a service-connected disability rating, it retains the right to reexamine you to determine if your disability is still present and warrants the original rating. ...

The VA can increase, reduce or terminate your disability compensation based on its reexamination. But, not every veteran’s disability rating is scheduled for a reexamination, and not every rating will change.

For example, some service-connected disability ratings are considered protected and will not be changed.

Veterans with a P&T rating (permanent and total) will usually not be scheduled for a reexamination. The same goes for injuries considered permanent or static. These include injuries that will never change, such as a missing limb.

Some medical conditions are not considered permanent and may be subject to reexamination.

Let’s take a look at VA reexaminations to better understand the details of why, when and how, the VA reexamines disability ratings, and whether or not your rating will be reviewed in the future.

If the VA reviews your disability rating ,keep in mind that reviews work both ways. They can increase or decrease your rating, depending on supporting evidence and documentation.

Why the VA Reexamines Veterans with a Service-Connected Disability Rating

Not all medical conditions are permanent. Some injuries heal over time. The VA wants to ensure they are compensating you for your injuries at an appropriate rate.

When the VA assigns you a disability rating, it will also determine if your condition needs to be reexamined in the future. This typically only happens for injuries with a reasonable expectation of improving over time.

When Can the VA Reevaluate, Terminate or Lower Your Disability Benefits?

Re-examinations are usually scheduled within two to five years after the initial examinations, or they can take place any time there is material evidence of your change of condition. This could be evidence that your situation has improved or disappeared.

If you’ve had a condition for five, 10 or 20 years, certain protections apply.

Protected VA disability ratings

Certain VA disability benefits are considered protected ratings, according to the VA (though others say the term “protected” is a misnomer).

This is where it helps to find and read the appropriate regulations or find an expert who can help you through the task. Here is a document that quotes some of the ratings protections for the 10- and 20-year rules (Word doc on VA site).

VA Disability Five Year Rule: If the rating has been in effect for five years, it cannot be reduced unless your condition has improved on a sustained basis. (The VA must have documentation supporting this is a permanent improvement.)
VA Disability 10 Year Rule: A service-connected disability rating cannot be terminated if it has been in effect for 10 years. Compensation can be reduced if evidence exists that the condition has improved. The sole exception is if the VA can prove fraud, in which case it can terminate the benefits.
VA Disability 20 Year Rule: If the rating has been in effect for 20 years, it cannot be reduced below the lowest rating it has held for the previous 20 years. The only exception is if the VA can prove fraud.
VA Disability 100% Rule: The VA must prove your medical situation has materially improved, and as a result, you are able to perform substantial work.

What do these protected ratings mean? If you have had a VA service-connected disability rating for five years or more, the VA must prove your condition has improved on a sustained basis before they can reduce or terminate your disability rating.

After 10 years, the VA can only reduce your rating; they cannot terminate it (absent proof of fraud).

After 20 years, your rating cannot be reduced below the lowest rating you have held for the past 20 years.

These distinctions are important because some ratings can vary over the years, based on the medical condition.

Let’s say you have a knee injury that warrants a 30% disability rating when you complete your initial VA evaluation. After five years, the VA can not reduce this rating below 30% unless they can prove the injury has healed on a sustained basis. If it has improved to the point it warrants a lower rating or the injury no longer exists, then the benefit can be reduced or terminated.

After 10 years, the benefit can no longer be terminated, but it can be reduced if the VA can document substantial sustained health improvements. After 20 years at that rating, your benefit can no longer be reduced below its lowest rating or terminated (unless there is proof of fraud).

The 100% rule is much more difficult to have decreased. The VA must prove your health has materially improved, and you are now able to perform substantial work. If all your injuries still leave you unemployable, then it is unlikely your benefit will be reduced.

Most veterans with a 100% rating have one or more major service-connected medical conditions, and possibly additional multiple less-severe injuries. The VA must prove the veteran is able to perform substantial work even with this assortment of medical conditions.

Notice of Reexamination Letter

The VA must send you a reexamination letter before they can change your service-connected disability rating. This letter will detail what will take place and when.

You have 30 days to request a hearing if you wish to contest the VA decision, and you have up to 60 days to submit evidence that a reduction in your rating is not warranted.

The notice of reexamination should include contact information where you can reschedule your appointment if necessary.

It’s essential you attend your reexamination appointment or work to reschedule it for a better time.

If you don’t attend the appointment or provide supporting evidence for your case, the VA can reduce or terminate your benefits without additional warning.

Reestablishing your rating could take some time, or may be impossible, barring a legitimate reason for missing the appointment.

Keep in mind, the VA cannot reduce your service-connected disability rating without first sending you notice. Failure to do so should result in a full reinstatement of your benefits.

When the VA will not schedule you for a reexamination

The VA will typically not request to reexamine your rating under the following conditions:

you are over age 55;
the disability is static (such as a loss of limb);
the disability is considered permanent and is not expected to improve (e.g., blindness, deafness);
the disability is already at a minimum rating for that particular disability; or
reducing an individual rating would not affect the total combined disability rating.

If the VA contacts you to reexamine your case and you meet any of the above criteria, contact them at the phone number listed on your notice of reexamination and explain why you do not believe you should be reexamined. You may be able to have the reexamination canceled.

Reducing your disability rating – VA must prove change in condition

The VA needs to establish substantial evidence of a change in condition before any change can occur to your service-connected disability rating. This puts the onus of the work on them. But ,you still need to be proactive to protect your rating and attend your reexamination appointment.

A reexamination is not the end of the world

A notice of reexamination may result in an increased disability rating if the situation warrants it. The VA will not go out of their way to increase your benefits rating for you.

If the situation is warranted by your examination, then they will increase your disability rating.

Keep this in mind if you are scheduled for a reexamination. Remember also that requesting an increase in disability ratings may result in a decrease if the VA can prove your medical condition has improved over time.

I recommend reading this article on having your VA disability claim denied to have a better understanding of your options and the appeals process.

Bottom line: A VA disability rating is not always a static rating that will remain unchanged over the course of your lifetime. Your rating may remain unchanged, but it could also increase or decrease, depending on circumstances.

If you feel there is a problem with your rating, it is best to find someone who specializes in VA disability claims and see if you can get them to help you with your claim.

What To Do If The VA Decreased Your Benefits

If you receive notice that your disability compensation benefits have been decreased, read the letter to make sure you thoroughly understand VA’s reasoning behind the rate reduction.

Then, if you still disagree with the reduction, you can file a Notice of Disagreement to kick off the formal appeal process. You have one year from the date the VA mails your reduction notification to file your notice of disagreement.

You’ll use the Notice of Disagreement form to declare what you disagree with and indicate how you’d like your appeal to proceed.

On your notice of disagreement form, you can request an opportunity to submit additional evidence for consideration, a higher-level review with the existing evidence from your original claim, or a hearing in front of a veterans law judge.

If you’re going to submit new evidence, gather all relevant paperwork to back up your appeal. You may find it helpful to enlist a lawyer or your own medical professionals to ensure you don’t miss anything.

If the VA reduced your rating after evaluating your disability, you need to provide evidence that proves the severity of your condition and its impact on your daily life. This can include private medical records, your VA health record and statements from people close to you.

The VA said the appeals process can take about five months to a year. If the VA grants your appeal, you’ll receive back-pay of your benefits to offset the reduction. If it doesn’t, you can start over by selecting a different review process on your notice of disagreement, or consult a lawyer specializing in veteran disability claims.

Where to Get Help if You Receive a VA Reexamination Notice

Author’s Note: I have received many inquiries relating to specific disability ratings and medical conditions. I am not medically trained and I am not authorized to speak on behalf of the VA. So I’m not comfortable commenting on specific medical conditions or situations. Please do not leave personal medical information in the comments section of this site, and please don’t send it via email.

Instead, I recommend contacting a benefits counselor at a veterans’ service organization. Many organizations have trained counselors that offer free veterans’ benefits claims assistance. These benefits counselors are able to offer one-on-one assistance and can help you review your VA benefits claim. This can be valuable as it can help you avoid common pitfalls and help your claim be completed more quickly and accurately.

Source: https://themilitarywallet.com/can-the-va-reduce-disability-benefits/