The VA reevaluates Post-Traumatic Stress Disorder (PTSD) disability ratings to ensure that the compensation a veteran receives accurately reflects the current severity of their condition and its impact on daily life. While the initial rating establishes the connection and severity, the VA maintains the authority to review and adjust that rating over time, especially if the condition is not considered permanent. The frequency of this review depends on specific factors the VA considers when the rating is first granted.
Understanding the Triggers for Reevaluation
The decision to reevaluate a veteran’s PTSD rating depends on whether the condition is classified as “static” or “non-static” at the time of the initial rating decision. A static disability is one the VA considers permanent and unlikely to improve, such as an amputation, which typically exempts the veteran from routine reexaminations. PTSD, however, is often initially classified as non-static, meaning it is expected to change or improve with treatment or the passage of time.
For non-static conditions, the VA generally schedules a reexamination to occur no less than two years and no more than five years after the initial rating decision is issued. This routine schedule allows the VA to verify the continued existence and current severity of the disability.
Routine reevaluations are not the only triggers for review; unscheduled events can also prompt a reexamination. If a veteran files a claim for an increased PTSD rating, the VA is obligated to confirm that the symptoms warrant the increase, which necessitates a review. Conversely, if a VA doctor notes a material improvement in the veteran’s condition during routine treatment, this medical evidence can also trigger an unscheduled reevaluation to determine if the rating should be reduced.
The VA must send the veteran advance notice of any reexamination request. Failure to attend the mandatory appointment can result in the automatic reduction or termination of benefits.
The Compensation and Pension Exam
Once a reevaluation is triggered, the veteran must attend a Compensation and Pension (C&P) exam for mental health, which is a required step in the process. This exam is typically conducted by a VA-contracted psychiatrist or psychologist who is tasked with assessing the veteran’s current functional impairment. The examiner reviews the veteran’s entire medical record and then conducts a structured interview to compare the current symptoms against the criteria in the VA Schedule for Rating Disabilities (VASRD).
The purpose of the C&P exam is not to provide treatment but to assess the severity and impact of the PTSD on the veteran’s occupational and social functioning. The examiner will ask detailed questions about the frequency, severity, and duration of symptoms like hypervigilance, sleep disturbances, social withdrawal, and irritability. The veteran’s demeanor, memory, and emotional state are closely observed during the appointment.
Following the examination, the clinician completes a Disability Benefits Questionnaire (DBQ) for PTSD, which documents the current symptom picture and functional limitations. The information captured in the DBQ is what the VA rating specialist uses to determine if the existing rating should be maintained, increased, or decreased. Veterans should prepare for this exam by detailing their current symptoms and gathering any private medical records or lay statements that provide evidence of the disorder’s effect on their daily life.
Criteria for Static and Protected Ratings
The goal for many veterans is to achieve a rating that is protected from routine future reevaluation, which can occur once a condition is deemed “static”. A static rating signifies that the disability is permanent in character and there is no likelihood of material improvement over time. While PTSD can be complex, it may be classified as static if the symptoms have been consistent and severe for a significant period.
Beyond the static designation, the VA has specific rules that protect a rating from reduction or termination, offering increasing levels of stability over time. The “5-year rule” establishes that if a rating has been in effect for five continuous years, it becomes stabilized and cannot be reduced unless the VA obtains clear and convincing evidence of sustained and material improvement.
Further protection is provided by the “10-year rule,” which means that once a service-connected condition has been in place for ten years, the VA cannot terminate or sever the service connection entirely, except in cases of proven fraud. While the rating percentage can still be reduced if evidence of improvement exists, the entitlement to compensation for the service-connected PTSD cannot be removed.
The highest level of protection is the “20-year rule,” where a rating held continuously for twenty or more years cannot be reduced below the lowest rating held during that period unless the original grant was based on fraud. Additionally, veterans over the age of 55 are generally exempt from periodic reexaminations unless there are unusual circumstances.