Injured or disabled Veterans in the United States receive disability ratings from the Department of Veterans Affairs. Their disability rating determines how much they may receive in disability compensation.
Over time, a Veteran’s medical condition can change, which may reduce disability rating and benefits amounts. However, the VA may not always reduce your disability rating and benefits.
After 20 years, the VA may not reduce your disability rating, even if your condition materially improves. Let’s look at the VA’s 20 year rule, what it means, and how it may affect your disability compensation.
The VA’s 20 year rule is a disability rating standard that prevents your rating from decreasing under certain circumstances.
Suppose your service-connected VA disability has been rated at or above a specific rating percentage for at least 20 years. In that case, the VA cannot legally reduce your rating below that level in the future.
Here’s an example to better understand the 20 year rule:
Say you have a 50% disability rating for your primary, service-connected PTSD. You can file a claim to increase your rating for PTSD if your symptoms worsen. You receive an increase in your PTSD rating by up to 70%.
Eventually, 20 years pass. By the time the 20 year mark rolls around, your PTSD symptoms have become manageable such that your new disability rating should be 30% instead of 50% or 70%.
However, because 20 years have passed, the VA cannot reduce your rating below 50%,as that’s the lowest rating your condition has maintained for two decades.
Think of the 20 year rule as protecting Veterans’ service-connected disability ratings as they age. Many Veterans still need significant financial assistance, especially as they age and have to manage the effects of their conditions or disabilities. Because of the 20 year rule, Veterans don’t have to worry about their benefits suddenly disappearing when they need them most.
Note that the 20 year rule applies to the lowest consistent rating that your disability had for over 20 years. As in the above example, if your PTSD rating increased to 70% after 10 years, it would not be protected at the 70% mark since your PTSD rating was over 50% for 20 years, not 70%.
The VA 20 year rule also affects VA retroactive pay and benefits.
When you receive a service connection for any disability, the VA will assign you a disability rating and an effective date. The effective date is the date at which point the VA assumes responsibility for paying you disability benefits.
Suppose you receive a rating that goes back for at least 20 years. Your disability rating will be automatically protected, even though the VA may have recently issued your rating decision.
Here’s an example:
Imagine you are a Veteran and have been trying to get your PTSD rated and service-connected by the VA for over 20 years. When the VA finally grants you a service connection, it sets the effective date back 20 years from the present day.
Therefore, whatever rating the VA assigns you is protected and will not decrease. So, if you receive a 40% disability rating, your PTSD rating will stay at 40% in perpetuity.
This effect also applies if the VA retroactively applies a rating increase to your service-connected disability. Suppose the VA changes its standards for disability ratings and symptoms and decides that your service-connected disability warranted a higher rating than it initially received. In that case, it may retroactively increase your disability rating.
If that rating’s increase goes back 20 years or more, it will automatically be protected by the 20 year rule.
The 20 year rule even applies to VA combined ratings. If you have a combined rating that has been in effect for over 20 years, the combined rating is also protected and may not be reduced by the VA.
This is true even if the VA improperly or erroneously assigned the combined rating.
Over time, certain elements of your condition or disability may progress. You may suffer from new symptoms or your symptoms may heal to some extent.
Suppose you have a disability, and your condition progresses so that you manifest new symptoms. In that case, the VA may need to assign you a different diagnostic code than your current one.
When this occurs, your original diagnostic code is closed out, and you get a new diagnostic code to represent your condition’s progress. Since this is a completely new rating, the 20 year rule does not protect it.
For example, if you have had PTSD for 20 years and recently developed sleep apnea, you could receive a new rating for the sleep apnea diagnostic code. Even though you’ve had PTSD for over 20 years, your sleep apnea is a new condition in the eyes of the VA. This means that the 20 year rule does not protect the sleep apnea disability rating.
Although the 20 year rule is fairly inflexible, the VA can circumvent or ignore it if the VA proves fraud on the part of the Veteran.
Suppose a Veteran commits fraud by lying about their service record, misrepresenting their symptoms, or providing false or erroneous medical information. In that case, the VA can deem the disability rating it previously assigned inaccurate. Then, the VA can choose to eliminate the disability rating or downgrade it to a lower percentage.
Veterans who legally and truthfully report their symptoms and receive a disability rating correctly do not need to worry about this affecting their rating protection.
The VA uses other long-term rating rules to protect ratings and decide when disability ratings may be decreased.
The VA five year rule means that the VA is not legally allowed to reduce a Veteran’s service-connected disability if it has been in place for five years unless the condition has demonstrably improved on a sustained basis.
Veterans must prove their condition materially improved with medical evidence to receive a rating decrease.
The VA 10 year rule is slightly different from other long-term disability rating rules. It means the VA can’t eliminate a disability rating if it has existed for at least ten years.
The VA may reduce the disability rating if it has sufficient medical evidence that the condition has improved.
Veterans don’t have to worry about rating reductions if they are over 55. So, if you receive a disability rating at 55, but your symptoms are partially improved or resolved by the time you are 56, you will still not see a rating reduction.
Any Veteran with a 100% total disability rating is protected from rating reductions for the most part. Under this rule, the VA can only reduce a Veteran’s rating if they can prove a material improvement in the medical condition(s) at hand.
The VA also must prove that the Veteran can work and perform most daily functions and no longer needs the 100% rating, which normally qualifies them for benefits like TDIU.
Suppose your service-connected VA disability has continually been rated at or above a specific rating percentage for at least 20 years. In that case, the VA will never reduce that rating below that level, no matter how your disability changes or improves.
Therefore, if you’ve lived with a disability at a specific rating for a long time, you don’t need to worry about suddenly decreasing compensation benefits.
It can be tough to know how exactly these rules may affect your case or whether you qualify for a rating lock-in. Berry Law’s knowledgeable Veterans law attorneys can provide invaluable assistance.
Contact us today for legal counsel regarding your case and assistance filing a disability claim.
Sources:
About VA Disability Ratings | Veterans Affairs
Benefit Rates – Compensation | VA.gov
Chapter 7. Permanent Disability Benefits | State of California
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