Unprotected Benefit RateUpdated: June 5, 2020
While many veterans believe that the disability benefits they receive each month from the VA will continue at the same rate, there are instances when benefits are reduced. Sometimes, the VA may try to lower or take away a veteran’s benefits if they believe the severity of the veteran’s condition must be re-evaluated. This can happen for several reasons, including having an unprotected benefit rate.
What is an unprotected benefit rate?
If a veteran has an “unprotected rate,” and their medical condition has improved, the VA can reduce their monthly disability benefit. A veteran has an unprotected benefit rate if:
- They have a disability rating that is above the minimum for that particular disability but is less than 100%.
- They have been receiving benefits for less than five years.
How does the VA change disability ratings?
The VA can reduce a veteran’s disability rating any time the VA determines that a medical exam shows that a veteran’s condition has improved. The VA is legally allowed to reduce a veteran’s benefits, but the VA must follow specific rules about how and when a reduction can occur. For all disability ratings, including unprotected ratings, the VA must review all evidence submitted by the veteran, and should not rely completely on a medical exam. Once a veteran has been notified that their benefits are being reduced, they should provide the VA with any evidence they have that shows their disability has not improved.
When the VA is considering reducing a veteran’s benefits, the veteran will receive a letter from the VA explaining that their disability rating is being re-evaluated, and that they must go to the VA for a re-examination. Often, this exam is a medical exam, but sometimes a veteran may be placed in the hospital for an observation period. These observations and examinations are used by the VA to determine whether or not a veteran’s disability rating and benefits match the severity of their condition. After the exam, the VA will review the physician’s report to determine whether or not the veteran’s condition has improved. If it has, the VA is likely to reduce the veteran’s disability rating and their benefits.
If a veteran has a disability that is expected to improve over time, the VA may schedule future re-examinations after the veteran has been awarded disability benefits. Once a veteran is approved for benefits, the VA will evaluate their condition to determine whether or not it is necessary to schedule a future exam. Most re-examinations are scheduled two to five years after the original approval date for VA benefits.
If the VA does not schedule a future re-examination with the veteran, the VA is legally required to inform the veteran in advance that they must attend a re-examination. If a veteran receives a notice for a re-examination, that means that the VA has reviewed their medical files and determined the veteran must be re-evaluated in order to ensure that their disability rating is still correctly correlated with their disability.
Once a veteran receives this notification letter, they have sixty days to submit any medical evidence they have proving that a reduction in benefits is unjust, and they have thirty days to request that the reduction be appealed.
What can a veteran do if their rate is reduced?
When the VA reduces a veteran’s benefits, the following must occur:
- The VA must notify the veteran that their disability benefits are being reduced
- The VA must schedule a pre-reduction exam for the veteran
- The VA must schedule a pre-reduction hearing
- The VA must provide the veteran with the opportunity to submit evidence and present their argument against the proposed reduction in benefits
When the VA decides to reduce a veteran’s benefits, any proposed reductions must be based on the VA’s review of the veteran’s entire medical history of their disability. Additionally, reductions must be based on a change in the veteran’s disability, not just a temporary reduction of symptoms. Any improvement in disability needs to be reflected in the veteran’s ability to function in their daily lives and at work.
Veterans who have an unprotected rating and have their benefits reduced can consult a veteran’s attorney to help them navigate the process. An attorney who is familiar with the VA claims process can help determine if the VA made a mistake in reducing a veteran’s benefits.
Veterans who have had their disability benefits reduced because the VA determined that their condition improved are able to ask for an increase if their disability becomes worse. When requesting an increase, veterans must provide all necessary medical evidence, in order to ensure their request does not result in a further loss of benefits.
Veterans who receive a letter from the VA notifying them of a reduction in their disability rating can do the following to help protect their benefits:
- Make sure to attend their re-examination scheduled by the VA
- Find an accredited veteran service organization representative that can help them navigate the VA system
The VA schedules re-exams for disability ratings approximately every two years; the first re-exam is usually five years from the date the rating decision was made. However, there are certain situations that do not require an exam to be rescheduled; any veterans who fall into the following categories can ask the VA to reconsider the decision to conduct a re-examination:
- If the veteran’s disability has not or will not change
- If the symptoms have continued without improvement for five years or longer
- If the veteran is 55 years old or older
- If the veteran is at the minimum rating for their disability
- If the veteran’s combined rating will not be affected
If the VA does reduce a veteran’s benefits, the veteran is allowed to appeal the decision by filing a Notice of Disagreement with the VA. The Notice of Disagreement gives a veteran an opportunity to let the VA know that they feel the decision is wrong; a VSO can help veterans file this form if they need assistance.
Heather Maxey works at a non-profit that addresses military ineligibility. She is an Army spouse, and met her husband while working as a Health Educator at Fort Bragg.