What Is The VA Disability 5-Year Rule?

The VA disability 5-year rule says that a Veteran cannot have their rating reduced if their condition has not improved in the first 5 years after they received their initial rating for the condition. This means that the VA cannot reduce the Veterans rating if it has been in place for 5 years, unless the condition has significantly improved.The VA is responsible for approving or denying disability claims filed by Veterans, and the Department also oversees the benefits that Veterans continue to receive after they qualify for disability compensation. 

In many cases, the benefits granted by the VA to disabled Veterans are given indefinitely. However, certain factors can prompt the VA to re-evaluate a Veteran’s condition to determine whether they should continue receiving the same level of disability compensation. 

Why VA Disability Ratings Can Change Over Time

The VA allows Veterans to maintain their disability ratings if their service-connected conditions continue to cause the same levels of symptoms. That means that if a Veteran starts noticing improvements in their condition, the VA may re-evaluate their condition and determine that they should no longer have the same disability score that they previously had. Veterans are often re-evaluated by the VA at specific points after they initially qualify for disability benefits. One of the points when the VA commonly re-evaluates a Veteran’s condition is two to five years after qualifying for disability benefits.

Prior to the five-year mark, the VA often does reexaminations if they think a Veteran has seen a noticeable improvement in the symptoms of their service-connected disability. If a Veteran has been receiving disability benefits for a condition that is considered treatable, the VA may assume that the Veteran’s chances of making a partial or full recovery are much higher. In other cases, the VA may presume that recovery will take longer than five years or that a Veteran may be disabled for life. 

If the VA finds that a Veteran has made at least a partial recovery from their service-connected condition, they may lower the Veteran’s disability rating. If a Veteran was previously severely disabled due to their condition and is now able to move more easily, obtain work more easily, or function more fully in everyday life, the VA may have grounds for lowering the Veteran’s disability rating. 

However, improvements in a Veteran’s condition do not necessarily mean that they have recovered – symptoms can come and go for many Veterans with service-connected disabilities. For many Veterans who receive VA disability benefits, every day is different in terms of the severity of their symptoms. Some Veterans may deal with much worse pain from a service-related disability one day and far less pain the next day. Because disability symptoms can be unpredictable, the VA can sometimes inaccurately gauge how far a Veteran has come in their recovery from their condition. Since symptoms are often hard to measure accurately in one day alone, the VA may sometimes need to be especially careful with their assessment of a Veteran’s condition. They should account for flare-ups. This means making sure that they consider the possibility that a disabled Veteran may see temporary improvements to their condition and have their symptoms worsen later.

Benefits of The VA 5-Year Rule

Because the VA often struggles to accurately assess a Veteran’s condition in the years after they first qualified for disability benefits, the 5-year rule can often benefit many Veterans. If the VA inaccurately concludes that a Veteran has seen major improvements in their service-connected disability or even made a full recovery, they may wrongly lower or discontinue that Veteran’s disability benefits. Many Veterans receive lower benefits than they deserve because the VA has assumed that their symptoms have become milder than they actually are. The 5-year rule helps eliminate this by not requiring Veterans to come in for a reexamination after receiving the same rating for a condition for 5 or more years.

The 5-Year Rule Accounts For Chronic Illnesses With Unpredictable Symptoms

In reality, many disabled Veterans continue to require treatment and disability compensation for years after they initially qualify for benefits. Many service-connected disabilities are chronic, meaning their symptoms can persist for years, decades, or even a lifetime. Sometimes, a service-connected disability will cause symptoms that flare up without an explanation, go away for some time, then reappear. Because many conditions have unpredictable symptoms that can come and go without warning, the VA must be especially careful with how they assess and rate Veterans in the years following their initial approval of a disability claim. 

The 5-Year Rule Accounts For Disabilities That Get Worse Over Time

In addition, some service-connected conditions can actually get worse over time, not better. Many Veterans may start dealing with new and unfamiliar symptoms years after they are initially diagnosed with a disability. If a Veteran starts suffering from new symptoms, they may be able to qualify for increased disability benefits.

The 5-Year Rule Accounts For Secondary Conditions

The VA’s 5-year rule accounts for the possibility that a Veteran may develop additional disabilities as a result of their service-connected condition. The VA recognizes secondary conditions — health problems caused or worsened by a service-connected disability – as grounds for a Veteran to receive disability benefits from the VA in many cases.

Many Veterans develop secondary conditions years after they are initially diagnosed with a service-connected disability. Other Veterans may have already had health problems prior to their diagnosis with a service-connected condition – but their primary disability may have made these secondary conditions get worse over time. Regardless of how a secondary condition develops or progresses, it can warrant an increase in a Veteran’s disability rating if the Veteran can prove that their secondary condition was caused or worsened by their primary service-connected disability.

You May Not Be Receiving The Benefits You Deserve. The 5-Year Rule Can Change That

The 5-year rule protects a Veteran from receiveing Veteran’s disability benefits based on the assumption that their condition has improved over time. Because of this, many Veterans have had their disability scores increased while still seeking treatment for their disabilities. If you are continuing to get treatment and suffer from a service-connected disability, you deserve to continue receiving disability compensation from the VA. If your condition is re-evaluated and your disability rating gets lowered, you can dispute the VA’s decision to lower your rating by making an appeal.

Appealing a VA decision can help you keep the benefits that you deserve – in some cases, the appeals process can even lead to an increased disability rating. If your rating has gone down after a VA re-evaluation, one of the best steps to take is recruiting a reliable attorney and appealing the VA’s decision. An attorney can help you make a successful appeal by assisting you in navigating the often-complicated VA appeals process.

How the 5-Year Rule Helps Maintain Your Disability Rating

To make sure that a VA re-evaluation of your condition does not cost you your disability benefits, make sure to indicate to the VA that your condition is still negatively affecting your life. Below are some of the most important steps to take that can help you maintain or increase your VA disability rating.

• Keep seeking treatment for your condition. If you are still suffering from the effects of a service-connected disability, make sure to continue visiting your doctor, taking any prescribed medications, and taking other practical steps towards recovery.
  
  If the VA sees an indication that they interpret as meaning that you no longer need treatment, they are highly likely to lower your rating or discontinue your benefits. However, as long as your service-connected disability is still negatively affecting your life, you deserve to continue being compensated by the VA.
• Make sure the VA has not lowered your rating by default. In some cases, the VA may lower a Veteran’s disability rating based on the assumption that their condition has improved. This is often the case for service-connected disabilities that are considered highly treatable – disabilities that typically have a timeframe for recovery.
  
  However, if you are still dealing with severe symptoms from a service-connected disability, the VA should not lower or discontinue your benefits.
• If your rating has been lowered, get a second opinion from your doctor. Through an Independent Medical Examination (IME), you can make a case to the VA that your disability rating should be maintained or increased. The results of your IME can be presented to the VA as part of an appeal.
• Consult a reliable attorney. Berry Law’s team of experienced lawyers are dedicated to helping Veterans get and keep the disability compensation that they deserve. If you are struggling to get the right rating from the VA, if your claim has been denied, or if you are starting the process of making an appeal, we can help.

Call us today for a free consultation.

Sources:

Chronic Conditions | CMS.gov

Secondary Conditions and Aging with Disability | National Center for Biotechnology Information

Common Secondary Service-Connected Conditions | MilitaryBenefits.info