When a veteran is injured or becomes ill due to active duty, the United States Department of Veterans Affairs will rate their disability on a percentage scale to determine appropriate compensation benefits. However, the veteran’s medical condition may change over time. This is when the VA might go forward with a proposed reduction in the original rating.
If there is medical evidence that a veteran’s service-connected condition has improved, the VA might notify the veteran that they are going to reduce the rating currently assigned. When this occurs, a veteran may see a drop in their disability benefits. However, there are certain instances where a veteran’s rating is protected and cannot be reduced by the VA. Today, we will look at when the VA is not allowed to reduce a certain rating.
The 20 Year Rule For VA Disability Ratings
If a service-connected VA disability has been continuously rated at or above a certain rating percentage for 20 years or more, the VA is prohibited from reducing the rating below that level. The only exception for this rule is if the VA discovers that the rating was based on fraud. For example, a veteran has been rated at 50% for PTSD for over 20 years. He then files a claim for an increased rating for his PTSD. The VA schedules the veteran for a C&P reexamination, in which a health care professional evaluates the current severity of the veteran’s PTSD symptoms. The C&P examiner ends up finding that the veteran’s PTSD symptoms actually meet the criteria for a 30% rating. Regardless of the C&P examiner’s findings, the veteran’s PTSD rating cannot be reduced under 50% because it is protected.
Sometimes a veteran might have just recently received an increased rating for a service-connected condition that they had previously been rated at a lower level for at least 20 years. When this is the case, the veteran’s CURRENT rating can be reduced, but it cannot be reduced below the rating that had been in effect previously. The current rating is not protected, but the lower rating is. For example, a veteran was rated at 20% for his back condition from 1990 to 2010. In 2010, the veteran received an increased rating of 30% for his back condition. The 30% rating can potentially be reduced if the VA finds evidence that the condition improved, but they cannot reduce the veteran’s rating below 20% because the 20% rating is protected.
The 20 Year Rule – Retroactive Awards
Once a veteran receives a service connection for a condition, the VA has to assign a rating and an effective date. If the veteran ultimately receives a rating that goes back for 20 years or more, that rating is protected even though the rating decision was just issued. For example, a veteran has been fighting to get his PTSD service-connected. The BVA finally grants service connection and sends the case back to the RO to assign a rating and effective date. The RO assigns a 30% rating with an effective date of at least 20 years ago. The veteran’s 30% rating is protected.
The same concept applies if a veteran receives a retroactive increased rating. Let’s say the same veteran who received the 30% PTSD rating after the BVA granted service connection, appeals the rating because he feels it should be higher. If the rating is increased to 70%, and the veteran can show that his condition should have been rated 70% all along, he will then have a protected rating of 70%.
The 20 Year Rule – Combined Ratings
Ratings for individual conditions aren’t the only ratings that can be protected. If a veteran has a combined rating that has been in effect for 20 years or more, that combined rating is protected and can’t be reduced. So even if a combined rating has been improperly assigned by the VA, that combined rating is protected if it has been in effect for at least 20 years.
The 20 Year Rule – Changes in Conditions & Symptoms
What about when a veteran’s condition progresses and begins to manifest in new ways? If a veteran’s condition progresses to a point that the current diagnostic code does not provide an accurate reflection of the veteran’s symptoms, a new diagnostic code will need to be assigned. When this happens, the VA is required to close out the original diagnostic code and assign a new diagnostic code that represents the progression of the condition. The new rating assigned under this new diagnostic code will not have the same effective date as the original rating. So, the new rating is not protected.
Sometimes a veteran’s condition may progress over the years causing the veteran to suffer from completely new symptoms in addition to the symptoms they have had over the prior years. These new symptoms may warrant a rating under a different diagnostic code. Although these symptoms may have been caused by a condition that has a protected rating, the rating assigned under the new diagnostic code will not be protected. This is because the VA considers the new symptoms as a separate and distinct disability that warrants a separate evaluation. The symptoms that have been present since the original rating will have a protected rating, but the new symptoms will not.
Another tricky situation arises when a veteran has 2 conditions that have been incorrectly rated as one disability for more than 20 years. In this case, the VA is allowed to re-rate the conditions as separate disabilities as long as the following requirements are met:
- The combined rating of the separate disabilities equals or is greater than the rating assigned to the prior single disability, and
- The effective date of for the separate disabilities is the same effective date of the prior single disability.
This means that the now separate disabilities both have their own protected rating. Also, the veteran’s combined rating will be protected.
Other Rules to Note: 5, 10, 55, & 100%
In addition to the 20-year rule, the VA has other guidelines in place for protected ratings. Here are some of the main rules you should know.
5 Year Rule
The five-year rule states that the VA can’t reduce a veteran’s disability that’s been in place for five years, unless the condition improved overtime on a sustained basis. The veteran will likely need to present medical evidence to prove the material improvement of their condition.
10 Year Rule
The 10-year rule functions a bit differently than the other rules. In this case, the VA cannot eliminate a rating that’s been in place for ten years or more. However, they can reduce the rating if they have medical evidence that the medical condition improves. As with the 20-year rule, there is an exception to this rule if the VA finds out that the original disability rating was based on fraud.
55 Year Rule
Veterans are also protected from rating reductions if they are over the age of 55.
If a veteran has a 100% disability rating, marking total disability, the VA can only reduce the rating if they prove material improvement in the veteran’s medical condition. They also need to prove that the veteran is able to work and perform daily functions. Again, this requires medical records among other forms of evidence.
If you are a former military service member who is concerned about your disability compensation or has questions about the VA rating system, contact the team at Hill & Ponton. Our law firm specializes in veterans and social security disability. We will ensure that you’re receiving fair VA disability compensation and fully understand your options.