The VA reexamines veterans with disability ratings occasionally to determine if their conditions have improved, stayed the same, or worsened. A periodic future exam, which happens every 2 to 5 years, can result in a higher or lower rating or one that stays the same. Veterans will not be reexamined if their rating is considered protected, which includes the 55-year-old rule.
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In this article about the VA 55-year-old rule
What is the VA 55-year-old rule?
Veterans who receive VA disability benefits for service-connected conditions are exempt from periodic future examinations once they turn 55 years old. This includes veterans who will be 55 by the date of a future examination, according to the VA Adjudication Procedures Manual.
There is an exception to the 55-year-old rule: the VA can request a reevaluation of a rating for a veteran over age 55 “under unusual circumstances.” The Code of Federal Regulations does not define circumstances that are considered unusual.
One example of an exception to the 55-year-old rule is that veterans who have completed treatment for certain cancers must be reexamined six months after completing treatment.
The VA 55-year-old rule is considered a protected rating
A protected rating is one the VA cannot reduce or take away even if a VA rule changes.
“The longer that rating has been in place, the stricter the rules are for the VA,” VA-certified disability benefits lawyer Cecilia Santostefano said.
Protected ratings that are based on the length of time a rating has been in place include:
- 5-year rule: A rating that has been in place for 5 years or more is considered to be stable and cannot be reduced unless the veteran’s condition shows “sustained improvement.”
- 10-year rule: A rating that has been consistent for 10 years or more cannot be eliminated (or severed, as the VA refers to it) unless there is proof of fraud, but a rating can be reduced if the condition has improved.
- 20-year rule: A rating that has been in place for 20 years or more at a certain level cannot be reduced below that level or eliminated unless there is evidence of fraud.
Other situations in which veterans may be exempt from future examinations include:
- If a veteran has a static disability, which is one the VA has deemed permanent (blindness, a lost limb, or complete incapacity)
- When a disability from disease is permanent and shows no sign of improvement
- If a veteran’s conditions show no significant improvement and no likelihood of improvement
- When the rating is a prescribed scheduled minimum rating (for example, if you have a 10% rating for degenerative arthritis, which is the lowest rating for the condition)
- When a combined rating would not be affected if the future examination would result in reduced evaluation for one or more conditions (for example, a veteran with a combined rating of 65% for urinary incontinence and traumatic brain injury might be exempt from reexamination if a lower incontinence rating wouldn’t lower the 65% combined rating)
The VA makes mistakes
A word of caution: just because you meet the criteria above doesn’t mean the VA won’t make a mistake and schedule you for a reexamination.
A 2018 report from the VA Office of Inspector General (OIG) found that the VA doesn’t always follow the rules about periodic future examinations. In the review of 300 veteran cases scheduled for reexamination, the OIG found that the request was unnecessary for 111 cases. Based on those findings, the report estimated that between March 2017 and August 2017, the VA scheduled unwarranted examinations for 19,800 veterans, which is 37% of VA disability cases over six months.
If you are mistakenly scheduled for an exam, contact the VA and explain why you should be exempt. If the VA insists that you attend an exam, you must go so you don’t risk losing your benefits for missing an exam.
How Woods and Woods can help
Veterans who are wrongly scheduled for reexamination or who are unhappy with the outcome of a reexamination may feel like the cards are stacked against them.
When you’re a client of Woods and Woods, we respond to your reexamination notice by helping you to provide evidence that shows why you should not be subject to a disability rate reduction.
If your reexamination results lead to a revocation of your benefits, we challenge the decision by helping you to obtain a doctor’s report, lay evidence, or a letter disputing the validity of the exam.
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FREQUENTLY ASKED QUESTIONS
The 55-year-old rule protects veterans from disability rating reductions by exempting them from periodic future examinations by the VA.
The VA may request a reexamination for a veteran older than 55 under “unusual circumstances,” such as after completing treatment for certain types of cancers.