Ratings Reference, Educational Guide

VA Future Reexaminations

Most veterans assume the VA reviews every rating every few years. Most ratings are never reexamined. The exceptions are narrow and rule-driven, and the rules tell you in advance which ratings can be revisited and which cannot.

Educational reference, not a guarantee about your specific rating. Whether VA schedules a reexamination for you depends on the diagnostic code, the original rating decision's language, your medical history, and current VA policy. If a reexamination notice arrives, read it carefully and consult a VA-accredited representative before responding.
The default rule
Under VA Policy Letter 21-01, reexaminations are limited to situations where a regulation explicitly requires one or where the rater documents "exceptionally compelling" reasons. The default is no reexamination. If the original rating decision did not schedule one, the VA generally cannot add one later without a specific trigger.

The four situations where VA can schedule a future reexamination

1. The rating schedule itself requires it Per-condition rule

Some diagnostic codes have built-in reexamination requirements written into the rating criteria. The most common: active cancers, conditions in remission with a mandatory wait-and-watch period, organ transplants, and certain blood and infectious disease ratings.

2. Temporary 100 percent rating after hospitalization Paragraph 29

Under 38 CFR § 4.29, a veteran hospitalized for more than 21 days for a service-connected condition can receive a temporary 100 percent rating during the hospital stay. A reexamination is scheduled to determine the ongoing rating once the temporary 100 percent period ends.

3. Temporary 100 percent rating after surgery / convalescence Paragraph 30

Under 38 CFR § 4.30, a temporary 100 percent convalescence rating can be granted after surgery requiring at least one month of recovery, or after immobilization by cast of one or more major joints. A reexamination is scheduled at the end of the convalescence period.

4. Prestabilization rating Paragraph 28

Under 38 CFR § 4.28, the VA can issue a prestabilization rating of 50 or 100 percent immediately after separation when the condition is severe and unstable. A reexamination is mandatory within 6 to 12 months to assign a permanent rating.

Where VA is prohibited from scheduling a reexamination

Under 38 CFR § 3.327(b)(2), the VA is specifically prohibited from scheduling a reexamination when any one of the following applies:

  • Static disability. The condition is unlikely to improve (for example, complete amputation, total blindness, anatomical loss).
  • Stable for 5+ years. Symptoms have persisted at the same level for at least 5 years and the disability is not likely to improve.
  • Veteran is over 55. Other than for unusual circumstances or where the rating schedule explicitly requires it.
  • Minimum rating. The current rating is at the minimum rating provided for the condition.
  • Combined rating wouldn't change. A future change in the individual rating would not change the combined rating.
  • Rating is 10 percent or less. Except in rare cases.
The age-55 rule is one of the most-cited. Many veterans receive an unexpected reexamination notice years after a rating decision; if you are over 55 and the rating is not in one of the "rating schedule requires it" categories, the notice may be procedurally improper. Raise it in writing on VA Form 21-4138 promptly.

Conditions where the rating schedule itself requires reexamination

The following categories have built-in reexamination requirements in their rating criteria. This is not exhaustive; the diagnostic code text controls in each case.

Active malignancies (cancers)

Most cancers carry a 100 percent rating during active disease, treatment, and a defined post-treatment window (commonly 6 months after cessation of treatment). Reexamination is scheduled at the end of that window to determine the residual rating based on remaining symptoms or organ damage.

Cancers in remission

Even after a residual rating is assigned, some diagnostic codes carry a periodic reexamination requirement to monitor for recurrence (commonly 2 to 5 years out).

Organ transplants

Heart, kidney, liver, and lung transplants carry a 100 percent rating for at least one year after the transplant. Reexamination is then scheduled to assess residual function.

Blood and bone-marrow disorders

Leukemias, lymphomas, multiple myeloma, and aplastic anemia have built-in reexamination intervals tied to treatment phase and remission status.

Active tuberculosis

Active TB carries a 100 percent rating during active disease, with a graduated reexamination schedule as the condition transitions to inactive status.

Temporary 100 percent under §§ 4.28, 4.29, 4.30

Prestabilization, hospitalization, and convalescence ratings all carry a mandatory reexamination at the end of the specified temporary period.

Certain mental-health prestabilization grants

50 or 100 percent prestabilization ratings for trauma-related mental conditions require a reexamination within 6 to 12 months to assign the permanent rating.

Some endocrine and metabolic conditions in early stage

Newly diagnosed diabetes complications, some thyroid conditions, and certain rare endocrine disorders may carry an initial reexamination to confirm the trajectory.

How the reexamination process works

  • Scheduling notice. VA mails a notice that a reexamination has been scheduled, with the date, time, location (or telehealth instructions), and the conditions being reexamined.
  • The exam. Conducted by a VA examiner or a VA-contracted examiner (LHI, QTC, VES, MSLA). Same DBQ format as the original C&P exam.
  • Proposed rating. If the examiner finds the condition improved, the VA issues a rating decision proposing a reduction. This is a proposal, not a final decision.
  • 60-day predetermination period. You have 60 days to submit additional evidence and 30 days to request a predetermination hearing before any reduction becomes final.
  • Final decision and effective date. If the reduction is finalized, it becomes effective the first day of the month following 60 days after the final notice.
The proposed-rating phase is the critical window. A proposed rating reduction can usually be defeated or limited by submitting current medical evidence showing the condition has not improved. The longer you wait, the harder it is to undo. See the dedicated guide on proposed-rating responses.

If you miss a scheduled reexamination

Under 38 CFR § 3.655, failure to report for a scheduled VA examination without good cause leads to specific automatic consequences depending on the type of claim:

  • Original claim: rated on the evidence of record (often resulting in a denial if no medical evidence exists).
  • Reopened or supplemental claim: denied for failure to report.
  • Reexamination of an existing rating: rating reduced to 0 percent (unless the condition has 5-year stabilization or other protection in place).
The reduction-to-0 consequence is automatic and severe. If you missed an exam because you did not receive notice, were hospitalized, or had a documented emergency, file an immediate VA Form 21-4138 with the evidence of good cause and request that the rating be restored. Acceptable good-cause reasons include illness or hospitalization, death in family, or non-receipt of the notice.

How to challenge an unauthorized reexamination notice

If you receive a notice and believe the reexamination is prohibited under one of the bars listed above (over 55, stable 5+ years, static disability, minimum rating, etc.):

  • Do not skip the exam. Failure to report has automatic consequences regardless of whether the notice was procedurally proper.
  • File VA Form 21-4138 (Statement in Support of Claim) before the exam, identifying the specific bar in 38 CFR § 3.327(b)(2) that applies and asking for the exam to be cancelled.
  • If the VA proceeds with the exam anyway, attend, then preserve the procedural argument in any subsequent response to a proposed reduction.
  • If a reduction is proposed despite the procedural bar, raise both the procedural argument and the substantive evidence (that the condition has not improved) in your predetermination response.

Sources and authority

Frequently asked questions

Is the VA "watching" my rating year by year?

No. Most ratings are issued and never revisited unless a specific reexamination was scheduled in the rating decision or the veteran files a new claim. Routine VA healthcare visits are not tied to rating reviews.

I am over 55 and got a reexamination notice. Is that legal?

It can be. The over-55 rule in 38 CFR § 3.327(b)(2) is subject to exceptions, including ratings the schedule itself requires reexamination of (cancers, transplants, etc.) and unusual circumstances. If your condition is in one of those categories, age 55 does not bar the reexamination. If it is not, raise the bar in writing on VA Form 21-4138 before the exam date.

The notice says my rating "may be reduced." Does that mean it will be?

No. The notice language is boilerplate. The actual reduction can happen only after the examination, a proposed rating decision, a 60-day predetermination period, and a final rating decision. You have multiple chances to submit evidence before a reduction takes effect.

If I have been at 100 percent for 20 years, can the VA reduce me?

Under 38 CFR § 3.344(a), evaluations that have been continuously in effect for 5 or more years are protected by the "stabilization" rule: VA must show "material improvement" demonstrable in ordinary conditions of life. After 20 years at the same rating, 38 USC § 110 makes the rating effectively permanent (cannot be reduced absent fraud). See the rating protections guide.

I missed the exam because I never got the notice. What now?

File VA Form 21-4138 immediately with the explanation, request that the rating be restored, and ask the VA to reschedule the exam. Good cause for non-receipt (wrong address, mail not delivered, on travel) is recognized under 38 CFR § 3.655. Provide whatever evidence supports the non-receipt (move date, USPS hold, etc.).

The VA scheduled a reexamination for my PTSD that has been at 70 percent for 8 years. Can they?

Subject to the 5-year stabilization rule under 38 CFR § 3.344(a) and the procedural bars in 3.327(b)(2). A reexamination is not automatically barred, but a reduction after the exam must be supported by evidence of material improvement, not just one examiner's snapshot. Mental-health ratings are a frequent area of disputed reductions; representation is recommended.

If the reexamination is for a cancer that the schedule requires, what should I expect?

The reexamination is typically scheduled at the end of the post-treatment window built into the diagnostic code (commonly 6 months after treatment ends). The post-treatment rating is based on residual symptoms or organ damage. If the cancer is in stable remission with no residuals, the rating may drop to 0 percent for that diagnostic code; if residuals exist (scarring, organ dysfunction, etc.), the rating reflects those.

Related guides

Rating reductions
When VA can lower a rating and how to defend it.
Rating protections
5-year, 10-year, and 20-year stabilization rules.
Proposed-rating response
How to use the 60-day predetermination window.
C&P exam prep
How to prepare for any VA examination.

RateMyVSO. Educational resource. Not affiliated with the U.S. Department of Veterans Affairs. Not legal advice. All RateMyVSO tools are free. Find a VSO representative for personalized guidance.