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VA Disability Rating Reexaminations and Reevaluations

Reexaminations

 

Rating Reductions

Under certain conditions, VA may reduce your disability rating. Legally, VA is able to reduce ratings, but must follow specific rules when doing so. The idea behind rating reductions is that some service-connected conditions will improve over time or with treatment. As such, VA wants to ensure it is compensating each Veteran according to their present level of disability. VA normally starts the process of reducing a rating under two circumstances: (1) scheduled reexaminations and (2) evidence of change in condition.

What is a Reexamination?

A VA disability reexamination is a medical examination used to re-evaluate the severity of your service-connected disability. After you are initially awarded disability benefits, VA will evaluate whether your disability is such that you ought to be scheduled for a future reexamination to determine if your benefits need to be adjusted. The types of service-connected disabilities that are most likely subject to re-evaluation include those that can be expected to improve over time. VA is required to send you advance notice of the need for a reexamination. It is very important for you to show up for this examination. If you fail to attend, and do not call to reschedule or explain why you are unable to make it, then it is likely that VA will reduce or terminate your disability benefits.

How Often Do Veterans Attend VA Reexaminations?

VA usually re-evaluates Veterans’ service-connected conditions on two occasions:

  • Six months after leaving military service; and
  • Between two and five years from the date of the decision to grant VA disability benefits.

The purpose of re-evaluation is to verify either the continued existence and/or the current severity of a service-connected condition. VA will also require re-evaluation in cases where it is likely that a Veteran’s disability has improved, such that there is evidence indicating there has been a material change in a disability or that the current rating percentage is incorrect. If there is a significant improvement to the Veteran’s health upon reexamination, VA may choose to assign a lower disability rating, thereby lowering the amount of monthly compensation the Veteran receives. VA may also determine that a disease or disability no longer exists, and discontinue benefits.

How Does VA Notify Veterans of a Reexamination?

As mentioned above, VA is required to send Veterans advance notice of the need for a reexamination. Typically, VA will call a Veteran or send a letter to let them know that the reexamination has been scheduled. When VA schedules you for a reexamination, it is imperative that you attend. If you do not go to the reexamination, you risk getting your disability benefits reduced. If you are unable to attend the reexamination, it is important that you notify VA as soon as possible. In this case, VA will likely work with the Veteran to re-schedule the reexamination without any penalty to the Veteran.

Results of VA Reexaminations and How to Respond

There are several potential outcomes or results of a VA reexamination. Specifically, VA may find that your condition has worsened and as a result, your disability rating may actually be increased. VA can also determine that there is no change in your service-connected condition. In this case, your disability rating would not be reduced and therefore your monthly compensation amount would remain the same. However, VA may find that your service-connected condition has improved in which case your disability rating may be reduced.

If the results of the VA reexamination are unfavorable, meaning VA found that the service-connected condition has improved, Veterans have the right to challenge the results. Here, Veterans can get an outside medical opinion from a private physician or healthcare provider. Additionally, Veterans can submit lay statements outlining the onset, progression, and severity of their condition. Finally, Veterans can write a letter to VA explaining why the examination provided was inadequate, if applicable.

When Are Veterans Protected From Reexaminations?

According to 38 CFR § 3.327, no periodic reexamination will be scheduled in service-connected cases when:

  • The disability is established as static
  • When the findings and symptoms are shown to have persisted without material improvement for a period of 5 years or more
  • Other protected VA ratings
  • Where the disability from disease is permanent in character and of such nature that there is no likelihood of improvement
  • In cases of Veterans over 55 years of age, except under unusual circumstances
  • When the rating is a prescribed scheduled minimum rating; or
  • Where a disability evaluation would not be affected if the future examination should result in reduced evaluation for one or more condition

VA Issued Thousands of Unwarranted Reexaminations

In July 2018, the Office of Inspector General (OIG) released a report that found that VA conducts thousands of unnecessary medical examinations for disabled Veterans, and is on track to spend more than $100 million over the next five years on these unwarranted reexaminations if nothing changes.   The OIG looked at a sample of 300 cases with reexaminations throughout a six-month period (March 2017 to August 2017) and found that VBA employees “requested unwarranted medical reexaminations in 111 cases,” approximately a third of the cases OIG selected for sampling. When looking at the data further, OIG stated that VBA employees requested reexaminations for Veterans who were supposed to be excluded from reexaminations for the reasons listed above.

By failing to properly assess if reexaminations were warranted, OIG estimated that “VBA requested 19,800 Veterans to report for unwarranted reexaminations during the review period.” OIG also found that approximately 14,200 of the 19,800 Veterans did not have their disability evaluations changed following the reexaminations, and 3,700 Veterans received VA proposals to reduce their disability benefits, even though they were not supposed to be reexamined in the first place.

Since then, VA has been working to implement the OIG’s recommendations of setting up internal controls that would ensure that a reexamination is appropriate before ordering it, and designing and implementing a system to minimize unwarranted reexaminations.

Source

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