Understanding the 5, 10, and 20 Year Rules for VA Claims | VetLaw

Veterans’ disability ratings are subject to increasing levels of protection the longer they stand, according to the VA’s 5, 10, and 20 year rules.

Summary

• The five, ten, and twenty-year rules stipulate under what conditions the VA can and cannot reduce a veteran’s disability rating.
• A disability rating indicates the extent of a veteran’s impairment and how long their service-related disability is expected to last.
• Veterans with severe disabilities that are highly unlikely to improve are typically protected from having their benefits lowered by the VA.
• Disability benefit claims based on false information are not shielded from being reassessed or nullified by the VA.

Veterans seeking benefits for a service-related disability usually have to undergo a medical exam to determine their disability rating. Along with other factors, this informs the amount of compensation they are eligible for. However, a disability rating from the VA is not necessarily set in stone. 

The VA operates under the 5, 10, and 20-year rules to determine if it needs to reassess a veteran’s disability rating. The prospect of having your service-related disability can be unnerving. At VetLaw, we’re here to make sure that you get the benefits you deserve. 

We have considerable experience dealing with the VA as veterans disability appeals attorneys, challenging unfair or flawed decisions to maximize our clients’ benefits. Reach out to us at (855) 434-2492 or complete our online contact form to schedule a free consultation.

Our team can help you understand what rights you have and how our services can benefit your claim. We’ll tell you what you should expect if the VA wants to reevaluate your disability rating.

Five Year Rule for Veterans Disability Claims

One of the first steps in the veterans disability claims process is typically to submit to a C&P exam. A VA healthcare provider will document your injury. They also collect information about how your military service caused it.

From there, the VA decides whether you qualify for disability benefits and what your disability rating is. After the original C&P evaluation, the VA has five years to request a follow-up exam called a Routine Future Examination (RFE).

This is known as the five-year rule. The purpose of an additional assessment is to ascertain whether your disability has improved. Depending on the VA’s findings, your disability rating and corresponding benefits may be adjusted.

Exemptions to the Five Year Rule That Prohibit the VA From Reassessing Certain Injuries

The five-year rule does not apply in every circumstance. First, the VA must reasonably expect that the disability in question will materially improve. Then, it can invoke the five-year rule and request a follow-up medical evaluation.

There are some cases where conducting a second exam to check for improvement would be pointless. The five-year rule excludes cases like these. For example, consider a situation where a veteran has lost their leg in combat.

Although the injury does not render them completely incapacitated, the VA still labels it a Permanent disability. They will never regain the function of the missing leg. Therefore, the VA would not have the right to seek another exam under the five-year rule because the condition won’t improve. 

If a service-related disability irreparably impairs a veteran’s ability to function, the VA calls it a Permanent & Total disability. These types of cases are also not subject to the VA’s five-year rule. 

Ten Year Rule for Veteran Disability Claims

Veterans who have had a disability rating for at least ten years are protected from the VA taking certain actions. The ten-year rule says that the VA cannot revoke a veteran’s disability rating if they have had it for a decade or more.

That means that the VA has to offer the vet some level of benefits, although there are limited exceptions.  Also, the ten-year rule is a moot point for a subset of veterans’ disability claims.

The VA can’t retract the disability rating of a vet with a Permanent disability designation or a Permanent and Total disability status because their conditions won’t change. This protects their access to 100% disability benefits like Special Monthly Compensation.  

Exemptions to the Ten Year Rule That Allow the VA to Cut Benefits

There are a few situations where the VA can alter a long-standing disability rating. The first is if the VA finds out that you committed fraud in order to qualify for your disability benefits.

Fraud could include providing false information on medical documents or exaggerating the extent of your injuries. Fabricating a connection between your military service and the disability you are claiming is also fraud.

The second is if your service-related disability has measurably improved enough to warrant a different disability rating. At that point, the VA can reduce your disability rating and benefits in accordance with your level of disability.

Twenty Year Rule for Veterans Disability Claims

A veteran who has held a disability rating for twenty years has reached a “continuous” status for their rating. After receiving veterans’ disability benefits for at least twenty years, the VA can’t to diminish it beyond a certain amount.

Whatever the lowest disability rating you had during that time becomes the minimum amount the VA must use to allocate your benefits, according to the twenty-year rule. Again, veterans with a Permanent or Permanent and Total disability rating don’t have to worry about the twenty-year rule.

The twenty-year rule has the same major exemption as the ten-year rule. So, if you made a fraudulent VA claim to secure benefits, the VA does not have to abide by the terms of the twenty-year rule after that time has passed.

Disabilities Likely to Be Reduced by the VA

While conditions with unprotected ratings are generally the most vulnerable to VA rating reductions, certain types of service-connected disabilities may be more likely than others to face scrutiny, even with the protection of the VA’s 5, 10, and 20 year rules.

Generally speaking, conditions that are curable, highly treatable, or manageable with medication, acute conditions, and disabilities with no or few complications are more susceptible to VA rating reductions.

For example, a veteran with a broken wrist could spend several weeks in a cast or even undergo surgery and emerge with no lasting effects. Once their service-related injury is no longer an impediment to their ability to earn an income and care for themselves, the VA would likely reduce or eliminate their disability benefits.

However, if a veteran developed a chronic condition like diabetes as a consequence of their military service, they would be less likely to face a rating reduction. With service-connected diabetes, they would require lifelong treatment and be at risk for a number of other secondary conditions, such as heart disease.

Choose VetLaw to Represent Your Veterans Disability Claim

Figuring out how the 5, 10, and 20 year rules apply to your veterans disability claim may not be straightforward. Let the experts at VetLaw help clarify the process. We take pride in advocating for injured veterans with the VA, which includes pursuing the VA disability rating that represents your condition.

At VetLaw, our team is committed to ensuring that your sacrifice is properly recognized in the level of disability benefits you receive. Our former clients can testify to this. We want you to know that you are not on your own. We’ll be with you through every step of the process, including filing an appeal if necessary.

Our team can offer you the benefit of our experience, the administrative resources to build a VA claim, and the reassurance that you will have the support you need as you navigate the disability claims system.

You can move forward with your appeal knowing that you have a dedicated and capable team of VA disability benefits attorneys looking out for your best interest.

Contact VetLaw For Help Applying the 5, 10, and 20 year Rules to Your Veterans Disability Claim

Navigating the various conditions associated with the VA five-year rule, ten-year rule, and twenty-year rule can be tricky if you don’t regularly deal with veterans disability claims as our team does. At Vet Law, we have the background, resources, and skills required to successfully secure the VA disability benefits you qualify for.

Give us a call at (855) 434-2492 or complete our online contact form today to schedule a free consultation with one of our veterans disability claim lawyers. We can provide additional insight as to how the VA’s five, ten, and twenty-year rules apply to your specific case.

Frequently Asked Questions

Can the VA re-evaluate service-connected mental injuries as well as physical injuries?

Yes. The 5, 10, and 20-year rules the VA uses to assess disability ratings do not distinguish between physical service-related injuries like lung cancer and mental service-related injuries like PTSD.

Can the VA request that I submit to another medical evaluation after the five years have passed?

This is a possibility. If your service-related disability heals enough to be considered substantially better than the initial C&P recorded, the VA may want to determine whether you should continue to receive the same level of disability benefits.

Understanding the 5, 10, and 20 year rules for veterans disability claims can help you know your rights.

Does the VA always reduce benefits after re-evaluating a disability rating?

No. Many vets assume that this is the case, but based on the results of your exam, the VA can determine whether you should receive a higher level of benefits, the same level of benefits, or a lower level of benefits.

If you feel that your re-evaluation does not accurately reflect the extent of your disability, get in touch with a veterans disability appeals attorney as soon as possible.

Can I ask the VA for a re-evaluation if my disability is worse?

The VA has certain rights that allow it to request medical information before providing benefits. However, veterans can still ask to be reassessed by the VA. For example, they believe that the deterioration of their service-related disability warrants a higher level of benefits.

This may require you to appeal an existing claim. Alternatively, you may need to file a new one to include a secondary condition.

How does the VA decide the severity of a service-connected disability?

Generally speaking, the VA will look at how your service-related disability has harmed your ability to care for yourself, hold a job, function independently, and maintain some quality of life.

Other important factors in determining a disability rating are whether the injury or illness will improve and how long it may take. Regardless, it is still a good idea to be prepared to defend your rating.

Keep thorough medical records of any evaluations or treatments you have received, and consider who you could ask to provide a lay statement discussing your disability in case you need to dispute a VA rating reduction.

What does the VA consider “material improvement” of a disability?

The VA is required to show a veteran’s disability has shown material improvement to reduce their rating, and consequently, benefits. A veteran’s symptoms must be less intense and/or frequent, and this progress must be sustained.

Even if a veteran’s symptoms have gotten better with time and treatment, that still does not automatically mean their condition has shown material improvement. The VA has the burden of proving that the symptoms’ improvement has actually translated into less impairment for the veteran in order to justify a rating reduction.

So if the symptoms of your service-connected disability have become less severe, but in your daily life you are not any more capable of working or living independently than you were before, it would not count as material improvement.

Can the VA reduce my disability rating if I’m over 55 years old?

Your VA disability rating is largely shielded from a rating reduction after you turn 55. At this point, your rating becomes protected. Then, you don’t have to worry about regular Compensation and Pension exams to evaluate your condition for improvement.