VA disability benefits are governed by specific rules and regulations set forth by the Department of Veterans Affairs (VA) Among these rules are the 5-year, 10-year, and 20-year rules, which require the VA to comply with certain legal requirements before the VA can reduce a Veterans service connected condition.
5-Year Rule:
The 5-year rule generally applies to veterans who have been granted service connection for a specific condition and have had the same rating for said condition for five years. According to this rule, if a veteran’s disability rating remains unchanged for five years, it becomes a stabilized rating and cannot be reduced unless all evidence of the record shows there was sustained improvement of the disability. This rule provides stability and assurance to veterans by protecting their disability ratings from arbitrary reductions based on one isolated examination.
Let’s delve deeper into the 5-Year Rule with an example:
Imagine a veteran, let’s call him John, who was granted a service-connected disability rating of 30% for post-traumatic stress disorder (PTSD) in 2017. From 2017 to 2022, John participates in weekly therapy and takes medication as prescribed by his doctor. However, in 2023, John filed an application to increase his PTSD rating and the VA schedules him for a C&P Examination. During that C&P Examination, the examiner marks that John’s symptoms have improved on medication and that he is doing better. However, John’s VA Medical Center records still show that his PTSD is just as severe as it was in 2017 and that he is taking an even higher dose of medication. According to the 5-Year Rule, even though one examination shows some improvement the entire evidence of the record does not show that John’s condition has improved. Therefore, the VA cannot reduce his disability rating because the VA failed to show sustained improvement. However, suppose John’s C&P Examination and his VA Medical Center records show that his PTSD has significantly improved, he no longer has panic attacks and is no longer taking any prescription mental health medication in 2023. In that case, the VA may reduce his disability rating for PTSD because the entire evidence of record shows sustained improvement.
Overall, the 5-Year Rule serves as a safeguard for veterans like John, ensuring that their disability ratings remain stable and providing them with the assurance that their benefits won’t be arbitrarily reduced without valid cause.
10-Year Rule:
The VA’s 10-year rule ensures that the VA cannot terminate service connection for a disability that has been in place for ten years. The VA may still reduce the rating for the service connected condition but the VA cannot sever service connection.
Let’s explore the 10-Year Rule in the context of VA disability benefits:
Imagine a veteran named Emily who served in the Army from 2000 to 2005. During her service, Emily sustained injuries to her left foot, which are well documented. Upon discharge, Emily files for service connection of both her right and left foot. The VA awards service connection for both feet as of 2006. As per the VA’s rating schedule, Emily receives compensation based on this rating to assist with the financial burdens resulting from her injury.
In 2016, Emily filed an initial application to increase her right and left foot condition. At that time, the VA realized that Emily had never suffered a right foot injury in service and that they never should have granted service connection for her right foot. Despite this, there is no evidence that Emily committed fraud when she initially filed to service connect her right foot. The VA simply made a mistake. In accordance with the 10-year Rule, the VA would not be able to sever the service connection of the right foot because Emily had been service-connected for 10 years, and there was no evidence of fraud.
In the alternative, Emily filed an Initial Application in 2010 to increase her food condition and at that time the VA realized their mistake. Emily would not be protected by the 10-year Rule and the VA could sever service connection of the right foot.
20-Year Rule:
The VA’s 20-Year Rule is a protection for veterans with service-connected disabilities. The VA’s 20-year rule means that if a disability has been continuously rated at or above a particular rating level for twenty or more years, the VA cannot reduce the rating below that level unless it discovers that the rating was based on fraud.
