Learn About VA Disability Rating Increases

Understanding VA Disability Rating Increases

The U.S. Department of Veterans Affairs (VA) assigns disability ratings to veterans who have service-connected conditions. These ratings range from 0% to 100% and determine the monthly compensation amount a veteran receives. A disability rating increase means the VA has reviewed a veteran's condition and determined that the severity has worsened, resulting in a higher rating percentage and potentially more monthly benefits.

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Disability rating increases are separate from the initial rating decision. When the VA first grants a disability rating, it's based on medical evidence available at that time. As conditions change, worsen, or as new evidence becomes available, veterans may request that the VA reconsider their rating. The VA can also initiate a rating increase on its own, though this is less common.

Understanding how rating increases work helps veterans know what to expect during the review process. The VA uses specific criteria to determine whether a condition warrants a higher rating. These criteria are detailed in the VA Schedule for Rating Disabilities, a document that outlines how different conditions are rated at various severity levels. For example, a veteran with knee pain might initially receive a 20% rating, but if the condition worsens to the point where it significantly limits mobility and function, the VA may increase the rating to 30%, 40%, or higher.

The rating increase process involves several steps. A veteran submits a request, the VA reviews the medical evidence, a VA doctor may examine the veteran, and then the VA makes a decision. The entire process can take several months to over a year, depending on how complex the case is and how busy the VA regional office is.

Practical Takeaway: Learn the difference between initial ratings and rating increases. If your condition has changed since your original rating decision, gather medical records and documentation that show how your condition has progressed. This information will be important if you decide to request a rating increase review.

How the VA Determines Rating Levels

The VA uses the Schedule for Rating Disabilities to determine what percentage rating a condition should receive. This schedule is based on medical and scientific evidence about how different conditions affect a person's ability to work and function in daily life. The schedule is regularly updated, and the VA considers many factors when assigning ratings.

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Each condition has multiple rating levels. For instance, a veteran with lower back pain might be rated at 10%, 20%, 30%, 40%, or 50% depending on how severe the condition is and how much it limits the veteran's activities. The ratings are based on specific criteria such as the range of motion in joints, the frequency and severity of pain, any neurological symptoms, and how the condition affects the veteran's ability to perform work-related tasks.

The VA also considers functional impairment, which means how much the condition limits what a person can do. A veteran with arthritis in both knees that causes severe pain and significantly limits walking and standing would receive a higher rating than a veteran with mild arthritis that causes occasional discomfort. The VA reviews medical records, imaging studies, test results, and the veteran's own description of how the condition affects daily life.

For some conditions, the VA uses specific measurements. For example, in hearing loss cases, the VA uses audiometric test results that measure how well a person can hear different sound frequencies. In cases involving mental health conditions like post-traumatic stress disorder (PTSD), the VA considers how the condition affects social and occupational functioning, sleep, concentration, and mood.

The VA rating schedule includes many different conditions related to military service. Common conditions include back injuries, joint problems, hearing loss, tinnitus, PTSD, traumatic brain injury, respiratory conditions, and digestive disorders. Each has its own set of rating criteria outlined in the schedule.

Practical Takeaway: Review the VA Schedule for Rating Disabilities as it applies to your condition. Understanding the criteria the VA uses will help you understand what information and medical evidence would be most useful when requesting a rating increase review. The schedule is available on the VA website and is written in medical and technical language, but the criteria sections explain what is required for each rating level.

Reasons Why Conditions Warrant Rating Increases

Veterans request rating increases for several common reasons. The most frequent reason is that a condition has genuinely worsened over time. For example, a veteran with a back injury might initially have controlled pain and good mobility, but over several years, the condition may deteriorate, leading to increased pain, reduced mobility, and greater functional limitations. Medical records documenting this progression would support a request for a higher rating.

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New or worsening symptoms can also prompt a rating increase request. A veteran might have initially reported pain in one area, but over time additional symptoms develop. A veteran with a knee injury might later develop problems in the other knee, or develop ankle or hip problems as a result of compensating for the original injury. These related conditions might be rated as separate disabilities or might increase the rating of the original condition if they're considered part of the same service-connected condition.

Sometimes veterans initially underestimated the severity of their condition or didn't have complete medical documentation at the time of their initial rating. They may later obtain additional medical evidence that shows the condition was actually more severe than originally documented. This new evidence can support a higher rating, even if the condition hasn't necessarily worsened since the initial rating decision.

Failed treatments or surgical interventions can also warrant rating increases. If a veteran underwent surgery or other medical treatment intended to improve the condition but the treatment was unsuccessful, this can be documented and presented as evidence that the condition is more severe or disabling than previously thought. Similarly, if a veteran develops complications from treatment, these can be factors in a rating increase request.

Mental health conditions like PTSD and depression sometimes worsen over time or become more apparent years after military service. A veteran might initially minimize symptoms or not fully understand how the condition affected their functioning. As years pass and the impact on daily life, relationships, and work becomes clearer, veterans may request rating increases for these conditions.

Practical Takeaway: Document how your condition has changed since your initial rating. Keep records of medical visits, symptoms, how the condition affects your daily activities and work, any treatments you've tried, and any complications you've experienced. This documentation will be valuable evidence if you decide to pursue a rating increase.

The Process for Requesting a Rating Increase

Veterans can request a rating increase through the VA's formal process. The primary method is to submit a Statement in Support of Claim, often called VA Form 21-4138, along with new medical evidence. This form allows a veteran to explain how their condition has changed and why they believe a higher rating is warranted. However, veterans don't need to use the form—they can also submit a letter requesting reconsideration with supporting medical evidence.

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When submitting a request for rating increase review, veterans should include medical records that show the current status of their condition. These records might include recent doctor's visits, hospital records, imaging studies, laboratory results, specialist evaluations, or reports from therapists or mental health providers. The more recent and detailed the medical records, the stronger the request will be. Medical records should ideally be from the time after the initial rating decision to show progression or change in the condition.

Veterans should also consider including a detailed explanation of how the condition affects their daily life, work, and relationships. The VA considers functional limitations, and veterans' own descriptions of these limitations can be important evidence. For example, a veteran might describe how back pain now prevents them from working, how a hearing loss affects their ability to communicate with family, or how PTSD symptoms affect sleep and concentration.

The request should be submitted to the VA regional office that handles the veteran's case. Veterans can submit requests by mail, in person at a VA regional office, or through the VA's online portal if they have an account. Some veterans work with service organizations or representatives to help prepare and submit the request, though this is optional.

After a request is submitted, the VA will review all available medical evidence in the veteran's file. In many cases, the VA will schedule a examination with a VA doctor to assess the current status of the condition. This examination is important because it provides recent, objective medical findings that the VA can use to make a new rating decision. The veteran should be thorough and honest during this examination, describing all symptoms and functional limitations.

Practical Takeaway: Gather all medical records dated after your initial rating decision. Write a clear explanation of how your condition has changed or worsened. Submit your request with these materials to your VA regional office. Keep copies of everything you submit and note the date you submitted it. Follow up