The Department of Veterans Affairs (VA) provides disability compensation to veterans with service-connected post-traumatic stress disorder (PTSD). This compensation is based on a rating schedule that assesses the severity of the condition’s impact on a veteran’s occupational and social functioning. To ensure the assigned percentage accurately reflects the current level of impairment, the VA periodically reviews disability ratings. This process is a routine part of the system designed to confirm that compensation aligns with the ongoing reality of the condition’s effects.
Standard VA Reevaluation Timelines
When the VA grants a disability rating for PTSD, a future reevaluation is often scheduled unless the condition is considered static. The VA determines the need for this review based on the possibility that the veteran’s condition may improve over time, particularly with ongoing treatment. If a reevaluation is deemed necessary, it is typically scheduled for a period of 2 to 5 years following the date of the initial rating decision or the last rating increase.
The purpose of these routine future examinations, sometimes called Compensation and Pension (C&P) exams, is to verify the current level of the disability. For conditions like PTSD, which can fluctuate in severity and respond to therapy, the VA uses these check-ins to see if the symptoms have stabilized or lessened. The VA’s regulations require that they exercise caution when scheduling these reviews, aiming to reduce the number of examinations where possible. If the initial medical evidence suggests a likelihood of improvement, the veteran should anticipate a reevaluation within this 2-to-5-year window.
A service-connected disability rating is considered “stabilized” if it has been in effect at the same level for five continuous years. Once a rating reaches this five-year milestone, the VA cannot reduce it unless there is evidence of sustained improvement over time. This stabilized status offers a degree of protection, making it more difficult for the VA to propose a reduction based solely on a single examination.
Factors That Prevent Rating Changes
A rating can be designated as a “static disability,” which means the condition is considered permanent and has little to no expectation of improvement over the veteran’s lifetime. For PTSD, a static designation is possible if the symptoms have been chronic, severe, and unresponsive to treatment over a long period, making future examinations unnecessary under 38 CFR 3.327.
Veterans who have reached the age of 55 are generally exempt from routine Compensation and Pension reexaminations. The VA recognizes that conditions are less likely to improve significantly in older populations, reducing the administrative need for mandatory check-ups. While not absolute, this “Age 55 Rule” means the VA will typically only schedule a reevaluation if there is clear medical evidence showing a material improvement in the condition or if the initial rating was based on an error.
The 10-Year Rule provides protection for veterans with long-standing service connection. Once a disability has been service-connected for ten years or more, the VA cannot sever that service connection entirely, meaning the condition cannot be taken off the list of service-connected disabilities. The only exception to this rule is if the VA can prove that the original grant of service connection was based on fraud. Although the percentage rating itself can still be reduced if evidence of improvement exists, the connection to service is secured by this ten-year milestone.
The most robust protection is offered by the 20-Year Rule, which safeguards both the service connection and the percentage rating. If a rating has been continuously in effect at or above a certain percentage for twenty years, it cannot be reduced below the lowest level held during that twenty-year period. Similar to the other rules, this protection can only be overcome if the VA provides proof that the original rating was obtained through fraud.
What to Expect During the Examination
If the VA schedules a reevaluation, the veteran will receive written notification well in advance of the required Compensation and Pension (C&P) examination. Missing this mandatory appointment without good reason can lead to the suspension or reduction of benefits. The PTSD reevaluation exam is conducted by a mental health professional, such as a psychologist or psychiatrist, who assesses the current severity of the condition.
The examiner will utilize the Disability Benefits Questionnaire (DBQ) for PTSD, which is a standardized form used to capture the medical evidence required for rating purposes. The focus of this examination is to document the frequency, severity, and duration of the veteran’s symptoms, and how those symptoms affect their daily life. The questions will center on the veteran’s current occupational and social impairment, looking for evidence of difficulties in maintaining employment, relationships, and general daily activities.
A crucial part of preparing for this exam is for the veteran to report their symptoms accurately and honestly, focusing on how they function on their worst days. The examiner needs to understand the current reality of the disability, not the symptoms from years ago or how the veteran functions during brief periods of remission. The findings from this C&P exam, documented on the DBQ, form the primary medical basis for the VA’s decision on whether to propose a change to the existing rating.
Rules Governing Rating Reduction
Should the C&P examination indicate a potential for a lower rating, the VA must adhere to a strict legal standard before any reduction can take place. This process is governed by due process regulations, specifically 38 CFR 3.105(e), which requires the VA to provide the veteran with advance notice of a proposed reduction. This notice must inform the veteran of the reasons for the proposed change and the evidence supporting it.
The VA cannot base a rating reduction on a single C&P examination that suggests improvement. To legally reduce a stabilized rating, the VA must demonstrate “sustained improvement” in the veteran’s condition. This standard means the improvement must be proven to have lasted for a significant period and be considered permanent, not merely a temporary remission of symptoms. The evidence must show a material change in the veteran’s ability to function under the ordinary conditions of life, including their capacity for work and social engagement.
The evidence must be based on a review of the veteran’s entire medical history, not just the most recent examination. This comprehensive review is a procedural safeguard designed to prevent reductions based on short-term positive changes. After receiving a notice of proposed reduction, the veteran has a right to respond by submitting new evidence within 60 days. The veteran also has 30 days to request a predetermination hearing, during which benefit payments continue at the current rate until a final decision is made.