How Often Does the VA Reevaluate Disability Ratings?

If you receive disability benefits from the VA, you know how important the payments you receive are. What some Veterans may not know at first, however, is that the VA will periodically request to reexamine you so that they can reevaluate your disability rating. The VA’s request for a “review examination” may seem routine at first, but in fact, it can have a significant impact on the benefits you receive. If your disability rating is lowered after a reevaluation, it can result in you receiving reduced payments.

At the Berry Law Firm, we believe Veterans who have risked their lives for their country should continue to receive the full benefits they’ve been promised to help them live with their service-related disabilities. With that in mind, we want to help you understand how to review exams work so that you don’t get blindsided and lose any of your disability payment.

Understanding a VA Medical Review Examination

The VA will periodically review a disabled Veteran’s file and order a medical examination to ensure that the Veteran remains disabled and eligible for the benefits he or she is receiving. Some service-connected disabilities can get better, which could result in a reduction of benefits. Many disabling conditions get worse over time, which may result in added benefits for a Veteran who does not already have a 100% disability rating.

In theory, a VA review examination is fair and makes sense. A Veteran can even request a review examination if the veteran believes that he or she should have a higher disability rating.

Typically, the VA will order a reexamination at two different points in time:

  • The first will be six months after your service ends.
  • The second will fall sometime in the range of three to five years after your service ends.

At each of these intervals, the VA will reevaluate your disability rating. Any changes to the rating could affect the amount you receive in disability payments going forward.

However, the Veterans Benefits Administration (VBA) has the authority to request reexaminations for veterans “whenever the VA determines there is a need to verify either the continued existence or the current severity of a disability” unless there is an exclusion for reexamination. If a reexamination has been authorized and scheduled, the Veteran is required to report for the exam or risk losing benefits.

A disabled Veteran should be excluded from reexaminations if one or more of the following reasons exist:

  • Over 55 years old at the time of the examination, and not otherwise warranted by unusual circumstances or regulation
  • Permanent disability not likely to improve
  • Disability without substantial improvement over five years
  • Claims folders contain updated medical evidence sufficient to continue the current disability evaluation without additional examination
  • Overall combined evaluation of multiple disabilities would not change irrespective of the outcome of reexamining the particular condition
  • Disability evaluation of 10 percent or less
  • Disability evaluation at the minimum level for the condition.

Review Finds Unwarranted VA Medical Reexaminations

A report released by the VA in July 2018, titled “Unwarranted Medical Reexaminations for Disability Benefits,” said of approximately 53,700 veterans’ cases subjected to reexaminations in a six-month review, 19,800 (37%) were unwarranted. Many Veterans qualified for one or more of the exclusions listed above, yet were summoned for a medical exam.

The report’s review team said approximately 14,200 veterans subjected to unwarranted reexaminations experienced no change to their disability evaluations because of their reexamination. But the review team estimated that the reexaminations resulted in proposed benefit reductions for about 3,700 veterans. Some reexaminations resulted in increases to veterans’ benefits.

The study found that VBA management routinely bypassed pre-exam reviews, which are to serve as an internal control to prevent unwarranted reexaminations. Instead, VA regional office managers routed cases directly to a Veterans Service Representative (VSR) to schedule reexaminations.

In addition to “undue hardship for Veterans,” the report’s authors wrote that, “Unwarranted reexaminations also created unnecessary work for VA employees, which reduced VBA’s capacity to process benefits claims and the Veterans Health Administration’s (VHA’s) capacity to provide healthcare services.”

The report included four recommendations for internal controls and reviews to minimize unwarranted reexaminations.

In a Washington Post report about the review, VA Press Secretary Curt Cashour said, “VA’s goal is to ensure all Veterans receive the benefits to which they are entitled under the law. While we apologize for any inconvenience to the affected Veterans, these exams were meant to ensure VA was meeting that goal.”

What Happens at a VA Medical Reexamination?

If you are ordered to a VA medical reexamination or you request one, a medical professional will conduct the exam. You may be examined in person, or you may be questioned by telephone if the VA decides an in-person exam is unnecessary.

The examiner may:

  • Ask you questions.
  • Perform a physical exam.
  • Send you for X-rays or lab work.
  • Observe your behavior.
  • Review your file with you.

The examiner is only involved in performing the medical review. Other VA specialists will review the medical report to determine whether your disability rating should be adjusted. One of three things will happen:

  • Your disability remains the same
  • Your disability has worsened and an increase in benefits may be appropriate
  • Your disability has improved and a reduction in benefits may be appropriate.

Get Help from an Experienced Veteran Law Attorney

If you receive a VA request for a medical reexamination, you must comply, or you will jeopardize your VA benefits. If something happens outside of the scheduled timeframe and your disability worsens, you may want to request a reevaluation yourself. You have the right to do so.

But a reexamination will lead to a reevaluation of your disability rating, which could lead to a reduction in benefits.

Consulting with an experienced Veteran law attorney can give you a better idea of whether you should request a VA disability reevaluation and what you should expect if one is ordered.

If your disability rating has been reduced after a reexamination, we can review your file and discuss the opportunities to appeal the decision.

At the Berry Law Firm, we are Veterans and we are proud to serve our fellow Veterans who need help appealing benefit decisions. You don’t have to go into battle alone. For more information on how the Berry Law Firm can help, contact us now for a free consultation and advice about your legal rights.