What Is Flare-Up
A flare-up is a temporary worsening of your service-connected condition that occurs between routine periods of stability or lower symptom severity. The VA recognizes that many conditions, particularly musculoskeletal disorders, mental health conditions, and autoimmune diseases, do not progress in a straight line. Instead, they cycle through periods of exacerbation followed by relative improvement. The timing and documentation of a flare-up can directly impact your disability rating and your ability to receive benefits during those difficult periods.
Flare-Ups in VA Rating Decisions
The VA rates conditions based on the average level of impairment you experience. However, the rating criteria in the Schedule for Rating Disabilities (VASRD) account for the fact that many conditions fluctuate. When a C&P examiner evaluates you, they assess your typical functional capacity across a representative timeframe, not just your condition on the day of the exam.
This is where documentation becomes critical. If you experience flare-ups lasting days or weeks, you should:
- Keep a symptom diary with specific dates, duration, and functional impact (unable to work, increased medication use, medical appointments)
- Obtain medical records from treatment during flare-ups, including visit notes, imaging, or lab work if applicable
- Request that your VA primary care provider or treating specialist document flare-up patterns in your medical record
- Submit this documentation with your claim or appeal, particularly if flare-ups affect your average level of functioning
Flare-Ups and C&P Exams
A significant risk in the claims process is scheduling a C&P Exam during a period of relative stability. If you undergo your exam on a day when symptoms are controlled, the examiner may underestimate your typical functional impairment. You have the right to request rescheduling if you are in the middle of a significant flare-up that prevents you from demonstrating your typical capabilities. Document this in writing to the VA.
When preparing for your C&P exam, provide the examiner with a written summary of your flare-up history. Include frequency (how often they occur per month or year), typical duration (3 days, 2 weeks, ongoing), and functional restrictions during flare-ups. A VSO or disability representative can help you present this information effectively.
Flare-Ups in Nexus Letters and Appeals
If you are appealing a rating decision, a nexus letter from your treating provider can address whether your service-connected condition causes flare-ups and how they affect your overall functioning. The provider should reference specific functional limitations that occur during flare-ups, such as reduced work capacity or need for assistive devices.
In appeals, flare-up documentation supports arguments that your average level of impairment warrants a higher rating. For example, if your PTSD flare-ups occur 2 to 3 times monthly and last 5 to 7 days each, with significant occupational or social impairment during those periods, this pattern supports a rating higher than a condition that remains stable.
Common Questions
- Will a flare-up during my C&P exam help my rating? Not necessarily. A single severe flare-up on exam day may reflect an atypical presentation rather than your average functioning. The examiner is trained to assess typical capacity. What helps is documented evidence of your pattern of flare-ups over months or years, which you can submit separately from the exam.
- Can I request a higher rating if I have frequent flare-ups? Yes. If flare-ups significantly reduce your functional capacity on a regular basis, and this pattern is medically documented, you can appeal your current rating and present this evidence to support a higher rating. A VSO representative can help structure this argument.
- What counts as documentation of a flare-up? Medical records (treatment visits, ER visits), prescription refill records showing increased medication use during specific periods, work absence records, and provider statements about flare-up frequency and functional impact all qualify. Personal symptom journals with specific dates and details strengthen your case when combined with medical records.