How Often Does the VA Re-evaluate Disability Ratings?

If you receive disability benefits from the VA, you know how important the payments you receive are. When a Veteran qualifies for disability benefits, it means they will have the financial support they need to care for their family and self, even if their disability has made it impossible for them to work

In many circumstances, a Veteran’s service-connected disability is so severe that they cannot maintain a job, which can mean that VA disability benefits are their only source of income. Many disabled Veterans have families to support. Reliable monthly compensation from the VA can help keep a disabled Veteran financially stable and able to care for their family. 

Some Veterans may not know at first that the VA will periodically request to reexamine any Veteran who has qualified for disability benefits. The VA reexamines Veterans who are receiving monthly benefits so that they can determine whether a Veteran’s disability rating should increase, decrease, or remain the same. 

The VA’s request for a “review examination” may seem routine at first, but 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. Likewise, if the VA reexamines your condition and finds that your condition has worsened, you may be able to qualify for increased monthly benefits.

At Berry Law Firm, we believe Veterans who have risked their lives for their country should continue to receive the full benefits the VA has promised them. These benefits can help Veterans live with their service-related disabilities and take care of their families. 

We want to help you understand how the VA’s rating review exams work so that you do not get blindsided and end up with a lower disability rating than you deserve. If your disability status is reevaluated and you end up with a lower rating, we can help you appeal to get the benefits that you deserve. With an experienced attorney on your team, you can appeal a VA decision to ensure you are receiving the disability compensation you are entitled to. An appeal can even end up increasing your disability rating in some cases.

How Often Do Veterans Attend VA Medical Review Examination?

Typically, the VA will order a re-evaluation of a Veteran’s medical condition on two different occasions:

  • The first will be six months after your service ends. This initial exam allows the VA to determine whether your condition has changed since you were on active duty. If you develop a service-connected disability after leaving the military, your first review exam will come six months after your claim is initially approved.

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

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. 

In some circumstances, the VA will assume that a Veteran’s condition has improved over time and may reduce their rating after a certain period of time. However, if you are continuing to seek treatment for your condition and are still suffering from symptoms, the VA should not default to reducing your rating. If your rating has been reduced based on the assumption that your condition has improved, you can appeal the VA’s decision to change your disability score with the help of an attorney.

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. If you have already been granted the highest possible disability rating, it is much harder for the VA to decrease your benefits. If a Veteran has maintained 100% disability status for more than five years, it is especially difficult for the VA to change their rating.

In theory, a VA review examination is fair and makes sense. A Veteran can even request a review examination if they believe that they should have a higher disability rating. If you feel that the VA has rated your condition lower than you deserve, you can have your condition reevaluated to potentially get a higher rating.

At each of these re-evaluation intervals, the VA will re-evaluate your disability rating. Any changes to your 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 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, “The 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 Berry Law, we are Veterans, and we are proud to serve our fellow Veterans who need help appealing VA rating decisions. You don’t have to go into battle alone. For more information on how we can help, contact us now for a free consultation and advice about your VA claim.

 

Sources:

https://militarybenefits.info/individual-unemployability/

https://medlineplus.gov/xrays.html

https://www.benefits.va.gov/persona/veteran-elderly.asp