VA Disability 55 Year Old Rule Exceptions

The VA Disability 55-Year-Old Rule means that VA cannot reexamine or change a veteran’s disability rating when the latter is over 55 years old without concrete reasons. But chances are that you may have heard a different definition of this rule.

You will be surprised to know that the ’55-year-old rule’ is nothing official and a term made up of people. Although, there are indeed many laws about veterans over 55 that correlate with our rule in question. Let’s dive deep into this matter.

VA 55-Year-Old Rule: Two Variations

If you surf the VA’s official site, you won’t find anything with the specific ’55-year-old rule’ title. However, when going through the relevant communities, you may find two variations of it.

Many refer to a federal guideline in the VA Adjudication Procedures Manual as the 55-year-old rule. Here, it is stated that disability benefits for veterans over 55 are protected, and VA cannot ask for reexamination without unusual occurrence.

VA also can’t reduce the disability rating after the veteran reaches 55 with a disability they got before that age. The Federal Agency hasn’t clarified what those unusual conditions are, though.

Another version of this rule is that anyone over 55 can’t receive VA compensation if the disabilities arrive after they turn 55 unless it is service-connected. This one doesn’t make sense since your disabilities must be service-connected for any and all VA benefits, regardless of age.

So, because of higher credibility, we are going with the former variations throughout this article as the 55-year-old rule.

Other Exceptions to Reexaminations Similar to the 55-Year-Old Rule

VA normally ask for reevaluations once every 2-5 years if they predict or find evidence of improvement or change in your conditions. But they may not ask for any reexamination for many specific reasons, not just because a veteran is over 55. Some of these exceptions are as below-

• VA 5-Year-Old Rule: If a rating on a certain condition is still for 5 years or over, it is a stable disability. VA cannot reduce this rating unless there is continuous improvement to the condition.
• VA 10-Year-Old Rule: If a rating on any disability stays the same for 10 years or more, VA cannot take away this rating completely but can still reduce it for any improvement.
• VA 20-Year-Old Rule: If a rating is the same for 20 years or longer, VA can neither take it away nor remove it.
• VA 100% Rule: If the overall VA rating of a veteran reaches 100%, AKA total disability, VA can’t lessen it unless it has material improvement shown in the medical reports.

Although, none of the above rules will work if the authorities find any evidence of fraud. Otherwise, the longer a disability rating remains the same, the harder it is for VA to reevaluate, remove, or reduce it.

VA 55-Year-Old: Exception

Under certain circumstances, VA may still need to ask any veteran over 55 for reexaminations. These are exceptions to the rule. For instance, regardless of age, VA will require an examination six months after you complete treatment for specific cancers.

VA’s Questionable Exception to the 55-Year-Rule: Mistake or Willingly?

VA often willingly breaches the federal rule that prevents them from reexamining any veteran over 55 years old. Moreover, they often ask for examinations from protected conditions without concrete reasons or circumstances.

The VA Office of Inspector General (OIG) discovered this in 2018 after inspecting and reviewing VA’s cases of reexamining veterans. According to this finding, VA asked 19,800 veterans for unwarranted or unnecessary examinations from March to August 2017.

But the bottom line is that there is very little you can do in this predicament. You may try mailing VA to request them not to schedule an examination, explaining why if it is unwarranted. But the chances are high that VA may decline.

So, what if you don’t attend an examination set by VA? In that case, VA can legally reduce or stop your disability benefit compensations as they see fit. So, it is better to go for it.

Other Cases When VA Can’t or Don’t Ask for Reexaminations or Evidence

Some other reasons and conditions may also rid a veteran from having to go for reexamination or gathering evidence for VA. Some of them may not be as assuring since VA may still decide to examine in those cases. They are-

Presumptive Illnesses: In many cases, VA assumes that your disability is service-connected without you needing to provide any evidence. In these cases, VA will approve your disability claim without asking for any proof.

Permanent Disability: When an illness is permanent with no hopes or symptoms of improvement, VA deems it permanent. Permanent disabilities don’t get any reexamination.

Static Disability: When you have a disability that is permanent by nature, such as losing an organ or limb or blindness, VA puts it in the static category. Since you can’t improve from these, VA won’t ask to examine them again. You are probably eligible for Special Monthly Compensation (SMC) here.

The Combined Rating Exemption: If there is no chance of reduction of a veteran’s total rating even when one or more particular disability ratings reduce, then VA may not reevaluate their conditions.

Other VA Benefits that You May Get as a 55-Year-Old Without Reexaminations Necessary

Aside from the regular VA disability rating, retroactive benefits, and monthly compensations, there are other benefits that you can receive. Senior veterans over 55 are more prone to receive these since their service-connected disabilities may worsen at this age.

Special Monthly Compensation (SMC): As mentioned before, if you have certain static service-connected disabilities when you lose the ability to use any organ or limb, you are eligible for the SMC benefit. It is regardless of age and is separate from the regular payments.

Currently, SMC is $128.62 for SMC-K, to $5,990.84 for SMC-N1/2 in 2023. There are various categories of SMC, and their rates change yearly.

Aid and Attendance (A&A): Aid and Attendance is another service from VA different from any regular ones. Veterans with difficulties doing daily activities, such as eating, bathing, and dressing, are eligible for A&A. The eligibility factors also include other criteria, including asset and income, to match.

There is no age limit for A&A, but usually, veterans over 55 get these benefits more often for obvious reasons.

Individual Unemployability (IU): If a veteran can’t do any job to support them financially for service-related disabilities, they are eligible for the IU benefit. However, you need to match any of the following factors-

• You must have at least one disability with a 60% VA rating or more. Or,
• You must have multiple disabilities with a least combined rating of 70% and one of them being at least 40%.

You get a monthly IU compensation equal to a 100% Rating ($3,621.95) as of writing (2023).

Final Note

While it is a federal law not to reduce, remove, or reexamine a 55-year-old veteran with service-related disabilities, VA does it constantly. So, unless the authorities do something about it, you must be prepared if VA calls you for reevaluations. You may consider getting an eligibility review from VA Disability Coach since a private medical report will help you during any examination. We wish you the best of luck.