Overview
The discussion explains the VA's 55-year-old rule relating to disability ratings, clarifies common misconceptions, and outlines actual protections for veterans' ratings along with practical recommendations.
The 55-Year-Old Rule Explained
- The VA's 55-year-old rule states veterans aged 55 or older generally should not have routine re-examinations unless special regulations or unusual circumstances apply.
- Routine Compensation and Pension (C&P) exams are usually scheduled every 2–5 years to evaluate disability changes.
- The rule aims to reduce automatic scheduling of these exams for older veterans, not to provide absolute protection.
Misconceptions About the Rule
- Many believe turning 55 fully protects their rating or prevents new claims; this is incorrect.
- The rule only stops routine automatic exams, not all reviews or rating changes.
- Veterans can still file new claims after age 55.
Situations Where Ratings Can Change After 55
- Filing new claims can prompt the VA to review all disability conditions.
- Surgery related to a service-connected disability may trigger a rating review.
- Certain conditions (e.g., infectious diseases) can still be monitored.
- "Unusual circumstances" can lead to exams, but the VA has not precisely defined what qualifies.
Actual VA Rating Protection Rules
- 5-Year Rule: After 5 years at one rating, the VA needs strong evidence of sustained improvement to reduce it.
- 10-Year Rule: After 10 years, ratings can be reduced with substantial medical evidence, but not eliminated unless there is fraud.
- 20-Year Rule: After 20 years, the rating cannot be reduced below the original level unless there is fraud.
- 100% Rating: Reduction requires significant evidence of improvement in daily functioning.
Recommendations for Veterans
- File outstanding claims before turning 55.
- Document all medical treatments and keep thorough records.
- If the VA proposes a rating reduction, veterans will be notified and can respond with evidence or request a hearing.
- Work with a VA-accredited attorney or representative if facing a reduction review.
Key Takeaways
- The 55-year-old rule reduces the likelihood of routine exams but does not fully protect disability ratings.
- Other rules based on the duration of ratings provide stronger long-term protections.
- Understanding these distinctions helps veterans make informed decisions about their benefits.