There's a quiet trick inside a lot of lowball rating decisions, and most veterans never spot it. The examiner notes your condition is "well controlled on medication," the rater treats the medicated version of you as the real you, and the rating comes in a step or two below what your underlying condition supports. Sounds reasonable, until you think it through: the disability didn't shrink. The pharmacy is just holding it down, every day, for as long as you keep taking the pills.
The courts have now said, clearly, that the VA can't do this. And the VA's reaction tells you everything about how much money is on the table.
The rule, in plain English
The principle isn't new. Courts held years ago that when the VA rates a condition, it can't factor in the relief provided by medication unless the rating criteria for that condition explicitly account for medication. If the schedule's criteria for your condition say nothing about treatment, you're supposed to be rated on the condition as it exists without the ameliorative effects of the drugs, because the schedule measures the disability, not the prescription's performance.
In
Ingram v. Collins, decided in 2025, the Court of Appeals for Veterans Claims applied that principle squarely to musculoskeletal conditions, the back, joint, and pain ratings that make up an enormous share of the system. The criteria for those conditions don't mention medication, so the VA can't silently discount your pain and limitation because the meds are doing their job. Rated without the pills' help: that's the standard.
The VA's response: change the rulebook
Here's where it gets telling. Rather than simply applying the ruling, the VA moved in early 2026 to amend the rating schedule itself, proposing changes that would build medication effects into the criteria, which would blunt the ruling going forward. That effort has drawn its own opposition and its own legal questions, and as of this writing the fight over the rule isn't finished.
We're not here to referee the policy argument. We're here to point at what it concedes: the difference between rating veterans with and without the ameliorative effects of medication is worth real money, at scale, or nobody would be fighting this hard over it. Which means it's worth real money on your individual rating too.
What this means for your rating right now
If you're rated for a musculoskeletal condition and your exams say "controlled with medication," your rating deserves a hard look. If the rater credited the medication in an area where the criteria don't mention it, that's legal error, and it's the kind of error that supports a
Higher-Level Review or appeal, not just a shrug.
If you're heading into a
C&P exam, describe your condition as it exists beneath the treatment: what the flare-ups look like, what happens when a dose is late, what the condition did before the regimen stabilized. That's not gaming anything; it's describing the disability the schedule is legally supposed to measure. Examiners write down what you give them, and "fine on my meds" gives them the wrong condition.
If a past decision leaned on medication to deny an increase, the reasoning in that decision may not survive contact with the current law, which is exactly what
decision reviews exist for. And watch the calendar: if the VA's schedule changes take effect, claims decided under today's criteria are decided under today's criteria, an argument we've made before about
why filing sooner beats filing later.
The bigger principle
Underneath the litigation is an idea worth holding onto for every condition you carry: you are not your best medicated day. The rating schedule exists to compensate the disability service left you with, and a system that docks you for complying with treatment punishes exactly the veterans doing everything right. The courts keep having to remind the VA of that. Your job is to make sure your file reflects it.
Where we come in
We're a veteran-led firm, and rating fights built on legal error are core work: the decisions that credited your medication where the law says they couldn't, the exams that scored the treated version of you. If your rating has ever felt lower than the condition you actually live with,
reach out and we'll read the decision the way the court would.
