• VA’s new rule rates veterans at their medicated functioning level, not their estimated unmedicated baseline
• The interim final rule overrides Ingram v. Collins and a decade of court decisions that favored veterans on medication
• More than 350,000 pending claims across 500 diagnostic codes are affected immediately with no prior public comment

WASHINGTON, DC (TDR) — The Department of Veterans Affairs published a VA disability rating medication rule on Feb. 17 that fundamentally changes how examiners assess the severity of service-connected conditions — effective immediately, with no prior public comment period and no waiting period before implementation.

The interim final rule amends 38 CFR § 4.10, the core regulation governing how the VA evaluates functional impairment, by adding two sentences that overwrite more than a decade of court precedent that had been pushing the system toward rating veterans at their unmedicated level of disability.

The new language reads:

“To ensure that disability evaluations are based on the actual level of functional impairment under the ordinary conditions of daily life, the medical examiner will not estimate or discount improvements to the disability due to the effects of medication or treatment, whether or not medication or treatment is included within specific rating criteria. If medication or treatment lowers the level of disability, the rating will be based on that lowered disability level.”

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In plain terms: if your pain medication brings your back condition from severely limited to moderately functional, your rating now reflects the medicated state — not an estimate of how disabled you would be without the pills.

VA Disability Rating Medication Rule: The Court Decisions Being Overridden

The rule explicitly targets Ingram v. Collins, a March 2025 decision by the U.S. Court of Appeals for Veterans Claims (CAVC). In that case, veteran Carlton Ingram had been rated 20% for a back disability and 10% for a left ankle condition. He took both over-the-counter and prescription medications — including opioids — to manage pain.

The CAVC ruled that because the diagnostic codes for Ingram’s musculoskeletal conditions did not mention medication in their rating criteria, the VA could not factor medication’s benefits into the rating. The examiner was required to estimate what the disability would look like without treatment and rate accordingly.

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Ingram built on a line of decisions stretching back to Jones v. Shinseki in 2012, which first established that when a diagnostic code does not explicitly factor in medication, adjudicators may not consider how medication mitigates symptoms. That principle was expanded through McCarroll v. McDonald (2016), Sharp v. Shulkin (2017) and other cases.

The VA argues the courts got it wrong. The Federal Register preamble describes the Jones line of cases as an escalating misinterpretation:

“Jones’s rule that the Board can’t insert new criteria into the diagnostic code when it decides a case has been twisted to now require that the Board affirmatively discount medication for diagnostic codes that don’t say anything about medication.”

That quote comes from Judge Kevin Falvey‘s concurrence in the denial of en banc review in Ingram, which the VA cites as supporting the need for corrective rulemaking.

The Scale: 350,000 Claims, 500 Diagnostic Codes

The VA’s own analysis reveals the scope of what’s at stake. According to the Federal Register filing, if Ingram had been allowed to stand, it could have been applied broadly to over 500 separate diagnostic codes, requiring re-adjudication of over 350,000 currently pending claims.

The Office of Information and Regulatory Affairs classified the rule as a major rule with $100 million or more in annual economic impact — while simultaneously classifying it as a “deregulatory action” under Executive Order 14192. That dual classification is notable: the rule carries massive financial consequences for veterans’ compensation but is framed as deregulation.

VA Secretary Douglas Collins signed the rule on Feb. 11, 2026. Nicole R. Cherry, Alternate Federal Register Liaison Officer, authorized publication. It was published in the Federal Register on Feb. 17 and took effect the same day.

VA Disability Rating Medication Rule: The VA’s Argument

The VA frames the rule as a clarification, not a change. The Federal Register preamble argues that existing regulations — specifically § 4.10’s focus on “the ability of the body as a whole … to function under the ordinary conditions of daily life” — already require examiners to evaluate veterans as they actually present, medications and all.

The department says the Ingram approach created an impossible standard for examiners:

“Ingram requires VA to retrain all of its medical examiners and adjudicators to make assessments and decisions based not on the evidence before them but instead based on what they hypothesize the evidence would show if a veteran’s disability were left untreated.”

The VA also argues that the unmedicated-baseline approach would have created perverse incentives. Under Ingram, two veterans with identical underlying conditions could receive different ratings based solely on how much each one’s medication happened to help — rewarding those whose medications were more effective with higher ratings, even though their actual daily impairment was lower.

The department cited the Federal Circuit’s observation that the VA Schedule for Rating Disabilities is designed to compensate for “the actual level of the earning impairment on the veteran” — language that, the VA argues, inherently includes a veteran’s current medicated state.

What Veterans Advocates Are Saying

The reaction from the veterans’ advocacy community has been sharp. HadIt.com, one of the longest-running veterans’ disability forums online, headlined its analysis: “Ingram v. Collins Is Dead.”

“The CAVC giveth, and the VA taketh away. A new interim final rule overrides Ingram v. Collins and a decade of court precedent that favored veterans on medication.”

Veterans’ disability attorneys have raised concerns about the practical impact. Before the rule was published, SG Legal Group noted a common misconception among veterans seeking higher ratings:

“Because my medication helps, my condition doesn’t meet the criteria for a higher rating. This is flatly incorrect under Jones and Ingram.”

Under the new rule, that misconception has effectively become policy.

Disability Law Pro, which had analyzed the Ingram decision, summarized the case’s original significance before the VA overrode it: the holding applied to “a huge percentage of veterans” who take any medication for muscle or joint pain. The VA was required to determine impairment levels as if the veteran were not taking medication while also considering functional loss during flare-ups.

What Didn’t Change — And Why That Matters

The rule’s scope has important boundaries. First, diagnostic codes that already explicitly factor medication into their rating criteria — such as certain mental health ratings under 38 CFR § 4.130 that reference “symptoms controlled by medication” at the 0% level — remain unchanged. The Jones line of cases only applied to codes that were silent on medication, and the new rule addresses that same universe.

Second, existing ratings are not automatically reopened or reduced. Veterans currently receiving disability compensation at a specific level will not see their checks change unless they file for an increase or their condition is scheduled for re-evaluation. However, if either of those triggers occurs, the new standard applies.

Third, the rule does not change how the VA handles flare-ups under DeLuca v. Brown (1995) and Sharp v. Shulkin (2017). Examiners are still required to consider functional loss during flare-ups — but the baseline from which flare-ups are measured will now be the medicated state, not the unmedicated one.

The Bigger Picture: A Rating Schedule From 1945

This rule change lands amid a broader reckoning with the VA disability system. A Government Accountability Office report released in January 2026 found that the VA’s earnings loss calculations for disability ratings remain based on data from 1945 — eight decades old.

GAO Director Elizabeth Curda testified before the House Veterans’ Affairs Committee:

“Without a rating schedule that fully reflects present-day changes in medicine and the labor market conditions, VA may overcompensate some veterans while undercompensating others.”

The VFW testified at the same hearing about the need for modernization, Rep. Morgan McGarvey (D-KY) urged the VA to seek feedback from veterans during the modernization process, and Iraq and Afghanistan Veterans of America CEO Kyleanne Hunter urged that “veterans’ voices should be included at the table.”

The medication rule bypassed that table entirely. The VA invoked “good cause” under the Administrative Procedure Act to skip the standard notice-and-comment period, arguing that advance public input was “impracticable and contrary to the public interest” because Ingram created immediate systemic disruption risk. A 60-day comment period is now open retroactively — veterans can submit comments through mid-April 2026 at regulations.gov under RIN 2900-AS49.

VA Disability Rating Medication Rule: What Veterans Should Do Now

For veterans with pending claims that may be affected, the HadIt.com analysis recommends:

“Contact a Veterans Service Organization (VSO), accredited agent, or VA-accredited attorney. This is new territory and the specifics will matter.”

Veterans whose conditions are stable and rated at a static level will not see changes unless they file for an increase. But those with pending claims, upcoming C&P examinations, or conditions scheduled for re-evaluation should understand that the Ingram standard no longer applies — their exams will evaluate their condition as it currently presents, medications included.

The public comment period represents one of the few formal mechanisms for pushback. Veterans, attorneys, VSOs and advocacy organizations can submit comments arguing that the rule should be revised, narrowed or withdrawn before it becomes permanent.

Does the VA’s decision to override a decade of veteran-favorable court precedent through emergency rulemaking reflect a necessary correction to an unworkable standard — or does it punish veterans for following their treatment plans by rating their managed conditions as less severe than they actually are?

Sources

My article was compiled using information from the following sources: Federal Register publication of the interim final rule, the pre-publication version of the rule at the Federal Register, HadIt.com’s analysis of the rule’s impact on veterans, Disability Law Pro’s summary of Ingram v. Collins, SG Legal Group’s analysis of the Jones and Ingram decisions, the CAVC’s full opinion in Ingram v. Collins, the eCFR text of 38 CFR Part 4, the GAO report on outdated VA disability rating criteria, Stars and Stripes’ coverage of the GAO findings, the VFW’s congressional testimony on rating schedule modernization, and Military.net’s overview of VA mental health rating criteria.

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