New VA Rule Ties Disability Ratings to Medicated Symptoms, Drawing Fire From Veterans Groups

A new Department of Veterans Affairs rule that took effect Feb. 17 changes how the agency evaluates disability ratings for millions of veterans, tying compensation to how well a veteran functions while on medication rather than to the severity of the underlying condition.

Public comments are being accepted through April 20 at regulations.gov under docket RIN 2900-AS49. The department had received more than 1,900 comments by publication time.

The interim final rule, titled "Evaluative Rating: Impact of Medication," amends the core regulation governing how the VA assesses functional impairment. It adds two sentences directing medical examiners not to "estimate or discount improvements to the disability due to the effects of medication or treatment" and stating that if medication lowers the level of disability, "the rating will be based on that lowered disability level."

The rule applies across all body systems, including musculoskeletal, cardiovascular, digestive and mental health conditions. It affects new claims and any existing disability that comes up for reevaluation through a clinical exam.

Veterans advocacy organizations responded within hours.

What Changed

For over a decade, veterans and their attorneys operated under court precedent that largely protected disability ratings from being reduced just because medication made symptoms more manageable. The key case was Jones v. Shinseki, a 2012 ruling by the U.S. Court of Appeals for Veterans Claims that held that the VA could not factor in medication's benefits unless the specific rating criteria for that condition mentioned medication.

In March 2025, the same court extended that protection in Ingram v. Collins, ruling that VA examiners evaluating musculoskeletal conditions must attempt to determine "baseline severity" without medication. That decision applied to a veteran who had been rated 20% for a back disability and 10% for an ankle condition while taking prescription painkillers including opioids.

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The VA's new rule overrides both decisions. In its Federal Register filing, the agency called the Ingram ruling an "erroneous interpretation" that would require re-adjudication of more than 350,000 pending claims across roughly 500 diagnostic codes. The Office of Information and Regulatory Affairs classified the rule as a "major rule" under the Congressional Review Act, estimating an annual economic impact exceeding $100 million.

Despite that classification, VA Secretary Douglas Collins, who signed the rule Feb. 11, invoked emergency authority to make it effective immediately, bypassing the standard 60-day Congressional review period. The VA also skipped the typical advance public comment period, arguing that the rule simply formalizes longstanding policy and that delay would cause "significant disruption" to benefits delivery.

How Veterans Groups Responded

Disabled American Veterans issued a statement expressing "extreme disappointment and alarm," accusing the VA of using "an unnecessarily expedited process that effectively shut out veterans from providing any meaningful input." DAV noted that the rule disregards clear court decisions and questioned how it will impact the more than 6 million veterans currently receiving disability compensation, most of whom take at least one medication.

Veterans of Foreign Wars sent a letter to Collins in which VFW National Commander Carol Whitmore, a former Army nurse, said the rule "could have unforeseen and harmful downstream effects for veterans" and called for "serious public scrutiny and possible legislative clarification from Capitol Hill." The VFW disputed the VA's characterization of the rule as longstanding practice, with the organization's National Veterans Service Director Michael Figlioli stating that if the policy had truly been consistent since 1958, "there would have been no need for repeated judicial clarification."

The VFW also raised concerns about veterans with fluctuating conditions, the impact of medication side effects on overall functioning, and potential safeguards against unfair reexaminations.

Combat Veterans of America called the rule "dangerous" and urged veterans to submit public comments, providing template letters on its website.

What It Means in Practice

The practical concern raised by advocates is straightforward: A veteran whose PTSD is partially controlled by medication may now appear less disabled during a compensation and pension exam than they would without treatment. The same applies to a veteran whose knee pain is managed by anti-inflammatories or whose blood pressure is controlled by daily pills.

Under the previous court precedent, examiners were required to consider what the disability would look like without medication. Under the new rule, the rating is based on how the veteran presents at the time of the exam, medication and all.

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Existing ratings are not automatically changed by the rule. But any veteran whose disability comes up for a scheduled reexamination after Feb. 17 will be evaluated under the new standard. New claims filed on or after that date are also subject to it.

Retired Army Col. Charles Garbarino, a physician who served three tours in Iraq, told Stars and Stripes he worries many veterans will stop taking their medications rather than risk a lower rating, particularly those prescribed drugs for post-traumatic stress disorder. "A lot of veterans prescribed medication for their service-related medical problems will cut it off, rather than lose compensation," Garbarino said.

What Happens Next

The Ingram case is reportedly on appeal to the U.S. Court of Appeals for the Federal Circuit. The new rule does not automatically moot that appeal, but it changes the regulatory landscape. If the Federal Circuit weighs in, its decision could affect how the regulation is applied going forward.

Veterans, advocates and organizations can submit public comments through regulations.gov until April 20. Both the VFW and DAV have indicated they plan to file formal comments and work with Congress to seek legislative clarification protecting the veteran-centric benefits system.

Veterans with pending claims involving medication effects should consult an accredited veterans service organization representative or attorney, as timing may be critical for cases argued under the Jones or Ingram precedent.

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