Understand that the VA can re-evaluate your disability rating at any time unless they have taken steps to declare you 100% permanent and total.
A fear of ‘poking the bear’ keeps some Veterans from filing for new claims or for a rating increase they deserve. When you understand the VA system and know what to expect, you can protect yourself. You will be less likely to live in fear.
Here’s how the system works:
When a military person separates from service and files a claim for a disability, that claim will be accepted or denied based on proof of service-connection. When the VA approves the disability claim(s), they will assign a rating, starting at 0% and continuing in 10% increments.
If you receive a 0% rating, you won’t be paid compensation. However, the VA concedes your disability is service-connected, and that can’t be taken away from you unless the VA proves fraud later.
After the VA evaluates all your accepted claims, you will end up with a combined disability rating. This rating is what determines the amount of VA disability compensation you receive every month.
Why the VA Wants to Reduce Your Rating
VA ratings exist so that Veterans receive the right compensation for their current level of disability. If you have a rated condition and the VA believes it can improve, they will likely schedule you to be re-evaluated at some point.
Based on the results of this re-evaluation, the VA may let your rating stand, or it will move to reduce it. The idea is to make sure you are being compensated for the current level of severity for your disabilities.
If the VA believes your current disability rating is no longer accurate, they will issue a Proposal To Reduce.
Due Process Works Like This
The VA sends you a notice proposing to reduce your rating. This is not a rating decision. You cannot appeal a proposed reduction like you can with a rating decision.
If you don’t agree with the proposed change, you have options. First, you have 30 days to request a hearing.
- If you request a hearing, the VA cannot reduce your rating until that hearing. This can buy you time to submit new evidence to fight the proposed reduction.
- Whether you request a hearing or not, you have 60 days to submit new evidence supporting why your rating should not be reduced.
- The VA may issue this notice for other reasons, not just medical ones.
- If medical improvement is the reason for the Proposal to Reduce, you should submit (if possible) recent medical evidence and opinions showing your disability unchanged or worsened.
The VA is only doing its job, trying to be good stewards because some conditions can improve. After all, the ultimate goal of medical treatment is to heal you.
Once the VA issues a rating decision that reduces your rating, it goes into effect. In your decision letter, you will see a specific date that highlights your new rating. It will say something like, “new rating effective July 1st, 2020”.
Don’t Agree? Appeal
If the VA issues a decision reducing your disability rating, and you don’t feel it’s appropriate, you now have the right to follow the normal appeals process. You start this by filing a Notice of Disagreement (NOD).
It stands to reason the VA must prove through medical evidence that there has been a change to your disabling condition since the last time they rated you. Improvement in your health must be supported by evidence provided in your entire medical history. It can’t be a temporary lessening of symptoms.
What evidence should you provide to fight against a rating reduction?
Two common types of evidence to submit are lay evidence and private medical opinions. Lay evidence comes from you or from those who witness the effect your disability has on your daily life.
Private medical opinions and ‘second opinions’ can show medically that your condition has not improved. The truth is, our physical bodies do not generally improve without an intervention like invasive surgery.
The opposite is usually the case, especially if you have physical injuries. This is because our bodies age and do not work as well as they used to. We can develop secondary disabilities, such as GERD, ED, or chronic depression, because of our underlying service-connected disabilities.
Sometimes the best strategy while fighting a reduction in benefits is to find other medical conditions that can be tied to your military service as well. You may be able to return your disability compensation to its former level and beyond by filing new claims.
You will need solid medical advice to maximize your benefits this way since you should not flood the VA with claims that cannot be supported. Nevertheless, finding other medical conditions in the 38 CFR that apply may be easier than you might think.
Are some conditions more likely to receive a rating reduction than others?
Yes. The VA uses diagnostic codes when assigning initial ratings. Some of these diagnostic codes flag the file and calendar it to be evaluated later. Any mental health claim, such as PTSD, is one example of a diagnosed condition that will be flagged.
The VA regularly sends C & P exam notices ‘out of the blue,’ catching Veterans with unprotected ratings off-guard. This happens even when your file does not have a diagnostic code that requires re-examination.
Unprotected Ratings? Are Any Ratings PROTECTED?
Yes, and as such, some ratings are far less likely to be challenged by the VA. The following are examples:
Veterans with totally disabling conditions who are not anticipated to improve over time may be identified by the VA as ‘permanent and total.‘ The VA does not designate all Veterans with a 100% disability rating as ‘permanent and total. They grant this status selectively.
Veterans who have conditions that have been at the same rating level for 20 consecutive years have a ‘continuous rating,’ AKA ‘protected rating.’ The only way the VA can reduce a continuous rating is to prove the rating was fraudulently obtained.
Veterans who have held the same disability level for five years or more have a ‘stabilized rating.’ However, it is still susceptible to reduction. A veteran can only “breathe easy” after the same rating has been in place for 20 consecutive years.
The VA can reduce a stabilized rating by medical means only if they prove through a C & P exam or other factors that the condition has improved. This requires more evidence on their part than if the rating has not stabilized.
If you receive a VA Proposal to Reduce, note the date so that you don’t miss any deadlines. Then call us to discuss your options. You probably have more than you think.
Strategic Veteran is a Veteran-run company that provides FREE resources to empower Veterans in the VA disability system. Call us at 800-761-9004 today.