Understanding the VA 55-Year Rule for Re-Examinations
If you’re not 55 years old yet, you’re going to want to pay close attention to this—because one day, you will be. And if you’re already 55 or older, you’re exactly where you need to be. This information directly affects you.
When the topic of VA re-examinations and the “55-year rule” comes up, you’ll often hear about a specific section of the M21-1 Adjudication Procedures Manual. Most people reference the general guidance that “veterans over the age of 55 are not routinely scheduled for re-examinations.” But there’s more to the story—specific, detailed guidance many overlook.
VA’s Guidance on Age and Re-Examinations
The M21-1, Section E, discusses this in detail under “Considering a veteran’s age in connection with review examinations.” This part is critical and includes an actual example from the VA, which makes the guidance clearer and easier to understand.
According to the VA:
“With only rare exceptions, veterans over the age of 55 must not be routinely called for re-examination.”
Now here’s the part that most people miss—when deciding whether a veteran qualifies for an age exemption, the VA should not just consider the veteran’s age at the time of the rating decision. Instead, they must consider the age the veteran will be by the time the re-examination is actually conducted.
Example: Why 55 Matters
Let’s break this down with an example given directly by the VA:
- A veteran born on March 7, 1963 files for an increase in his service-connected PTSD (currently rated at 50%).
- Medical evidence supports an increase to 70% but also shows the veteran has begun therapy, with a good chance of improvement.
- The rating decision is prepared in February 2017.
- Typically, a follow-up exam would be scheduled for February 2020 (3 years later).
- Even though the veteran is only 53 at the time of the decision, he will be over 55 by the time the future exam is scheduled.
Result: No re-examination is scheduled. The condition is deemed static, despite a hopeful prognosis for improvement.
This is a major benefit for older veterans. If you’re 55 or older—or will be by the time of your next exam—you may be exempt from routine re-evaluations unless there are rare, specific circumstances (like a cancer in remission).
Important Notes and Exceptions
Here’s what else the VA considers:
- Unusual Circumstances: The VA may still require a re-exam if there’s a compelling reason. These must be clearly documented.
- P&T (Permanent and Total) Veterans: Typically not subject to future exams.
- Future Review Controls: If discovered during an unrelated claim, they must be canceled if the veteran is 55+ at the time of the scheduled exam—again, unless required by regulation or unusual facts.
The M21 also outlines several other related topics, such as:
- When to schedule and not schedule future exams
- Timelines (typically 18, 24, or 30 months)
- Re-examinations and stabilized or static disabilities
- Failure to report for a scheduled exam
Bottom Line
If you’re under 55, this will be important for you in the future. If you’re 55 or older, it could significantly impact your VA re-examination schedule right now. Make sure your file reflects your age appropriately, and if you’re nearing that 55-year threshold, keep an eye on how future exams are planned or canceled in your record.
When in doubt, consult with a VSO (Veterans Service Officer) or legal representative who understands the M21-1 guidelines and the nuances of VA disability law.
Disclaimer: This article is for informational purposes only and does not constitute legal or professional advice. If you are not 55 years or older, this is still worth understanding—your time will come. If you are 55 or older, this guidance is especially critical to your case. Always consult with a qualified representative when navigating VA claims or re-examinations.
