How to Successfully Contest a Proposed VA Disability Rating Reduction
Receiving a proposed VA disability rating reduction can be a daunting experience for veterans. However, with the right approach and timely action, you can effectively challenge the reduction and protect your benefits. This article outlines the steps to fight a proposed rating reduction, explains key VA rules, and offers practical advice for maintaining your disability rating.
Understanding a Proposed VA Disability Rating Reduction
A proposed rating reduction occurs when the Department of Veterans Affairs (VA) believes there is medical evidence suggesting that your disability has improved. To counter this, you must provide positive medical evidence that demonstrates your condition has not materially improved and continues to warrant your current rating.
Key Action: Obtain a Disability Benefits Questionnaire (DBQ) from a qualified medical professional who can attest that your condition remains unchanged or has worsened. For example, if the VA claims your knee condition has improved, a doctor’s DBQ stating “the knee condition is unchanged” can be critical evidence.
Steps to Fight a Proposed Rating Reduction
- Act Quickly: The VA typically provides a 60-day window to respond to a proposed reduction. This timeline is short, so prompt action is essential. Requesting a hearing can extend this period, but you must still prepare your evidence.
- Gather Positive Medical Evidence: Submit medical records, DBQs, or other documentation that supports the severity of your disability. This evidence should counter any negative medical findings cited by the VA.
- Review Your VA Claims File: Obtain your VA claims file to understand the evidence the VA is using against you. This file may also include your rating code sheet, which indicates whether your disability is static or scheduled for a routine future examination (RFE).
- Consult a Veterans Service Officer (VSO): A VSO can provide expert guidance on navigating the appeals process and submitting a compelling response to the VA.
Key VA Rules Governing Disability Ratings
Understanding the VA’s rules can help you better prepare for and respond to a proposed rating reduction. Below are the primary rules that apply:
What Is a Static Disability?
A static disability is considered permanent due to its nature, history, and severity. These disabilities are assigned a permanent evaluation and do not require routine future examinations (RFEs) to assess improvement. If your rating code sheet lists your disability as “static” with no RFE scheduled, your rating is less likely to be re-evaluated.
What Is a Permanent Disability?
A permanent disability is one where medical evidence indicates the level of impairment will persist for the veteran’s lifetime. This means the disability is unlikely to show material improvement over time, a key factor in VA evaluations.
The VA 5-Year Rule
The VA 5-year rule allows the VA to re-evaluate a disability rating within five years of the initial examination if the condition is expected to improve. However, after five years, re-evaluations are less common unless significant medical evidence shows improvement.
The VA 10-Year Rule
Under the VA 10-year rule, the VA cannot eliminate a disability rating that has been in place for 10 years or more, though it can reduce the rating if medical evidence shows improvement. For example, a 50% rating for migraines may be reduced to 0%, but the service connection remains intact. An exception exists if the VA determines the original rating was based on fraud, which could lead to the rating being revoked entirely.
The VA 20-Year Rule
After 20 years, a disability rating is generally protected from reduction, regardless of improvement, unless fraud is involved. This is the most secure milestone for veterans, allowing them to pursue additional claims, such as Special Monthly Compensation (SMC), without risking their existing rating.
The VA 55-Year-Old Rule
The VA’s 55-year-old “rule” is a policy, not a law, suggesting that veterans aged 55 or older are protected from rating reductions. However, this policy is not consistently enforced, and reductions have been reported for veterans well beyond this age. Veterans should not rely on this policy alone to safeguard their benefits.
The VA 100% Rule
For veterans with a 100% total disability rating that is not permanent and total (P&T), the VA can reduce the rating if medical evidence shows material improvement. However, a 100% P&T rating, where all conditions are static, is highly protected. The easiest way to jeopardize a 100% P&T rating is by filing new claims unnecessarily, as this invites VA scrutiny.
Special Considerations for 100% Permanent and Total (P&T) Ratings
If you have a 100% P&T rating, congratulations—you’ve achieved what many veterans refer to as the “Hundo Club”! This status means your conditions are static, and no RFEs are scheduled. To maintain this rating:
- Avoid Filing Unnecessary Claims: Filing new claims, such as for conditions like migraines when you’re already at 100%, provides no additional benefit and risks triggering a re-evaluation. The only exception is pursuing Special Monthly Compensation, which applies in specific circumstances.
- Monitor Your Rating Code Sheet: Ensure your conditions are listed as static with no RFEs scheduled.
Can Working Affect Your VA Disability Rating?
In most cases, employment does not impact your VA disability rating. The VA encourages veterans to work if they are able, as it promotes financial independence and well-being. However, veterans receiving Total Disability Individual Unemployability (TDIU) benefits must be cautious. TDIU is based on the inability to maintain substantially gainful employment, and significant income could prompt a re-evaluation. A workaround, such as working in a sheltered work environment (e.g., a home-based business), may allow you to earn income without jeopardizing TDIU benefits.
Final Tips for Protecting Your VA Disability Rating
- Stay Proactive: Regularly review your VA claims file and rating code sheet to anticipate potential re-examinations.
- Prepare for Re-Examinations: While most re-examinations result in reductions, a small percentage lead to rating increases. Ensure you provide comprehensive medical evidence during these exams.
- Avoid Fraud: Always provide accurate information to the VA. Fraudulent claims can lead to severe consequences, including loss of benefits, fines, or legal action.
Conclusion
Fighting a proposed VA disability rating reduction requires swift action, strong medical evidence, and a clear understanding of VA rules. By obtaining a DBQ, reviewing your claims file, and consulting with a VSO, you can build a robust case to protect your benefits. For veterans with 100% P&T ratings, avoiding unnecessary claims is critical to maintaining your status. Stay informed, be proactive, and don’t hesitate to seek professional assistance to safeguard your hard-earned benefits.
Disclaimer
The information provided in this article is based on the author’s opinions and experiences and is intended for informational purposes only. It is not a substitute for professional legal or medical advice. Veterans should consult with a qualified Veterans Service Officer (VSO), attorney, or medical professional for guidance specific to their situation. The VA’s policies and procedures may vary, and individual outcomes depend on the evidence and circumstances of each case.
