If you take medication for a service-connected condition, a major legal victory could affect your VA disability rating. The Ingram v. Collins case (March 2025) ruled that VA must disregard the beneficial effects of medication when rating musculoskeletal disabilities. This guide explains the ruling, what it means for you, and how to leverage it for your claim.
⚠️ Current Status (February 2026): The Ingram v. Collins ruling currently stands and has been appealed to the Federal Circuit. The VA may respond with regulatory changes, but as of now, the court's decision requiring VA to disregard medication effects remains the applicable precedent for musculoskeletal conditions.
The Background: Why Medication Matters
Here's a scenario many veterans face: You have chronic back pain from service. Without medication, you can barely move—your range of motion is severely limited. But with Tramadol, you function reasonably well. Should VA rate you based on how you are with medication or without it?
This question has been at the center of VA disability law for over a decade, and the answer directly affects your monthly compensation.
The Jones Rule (2012): The Original Standard
The legal foundation started with Jones v. Shinseki (2012), where the U.S. Court of Appeals for Veterans Claims established a crucial principle:
The Jones Rule: If a diagnostic code does NOT explicitly mention medication as part of the rating criteria, the VA cannot consider the beneficial effects of medication when assigning your rating.
In plain English: Unless the rating criteria specifically say "with medication," you should be rated based on your unmedicated baseline severity—how bad your condition would be if you weren't taking your pills.
Why This Mattered
The reasoning was sound: Veterans shouldn't be penalized for following their doctor's orders. If your medication masks a severe disability, your rating should still reflect the underlying severity—not the artificially improved state.
Ingram v. Collins (March 2025): The Expansion
Carlton H. Ingram, a veteran with service-connected back and ankle disabilities, appealed his ratings. He argued that the VA had improperly considered the beneficial effects of his pain medication when evaluating his conditions.
On March 12, 2025, the U.S. Court of Appeals for Veterans Claims issued its decision in Ingram v. Collins, 38 Vet. App. 130 (2025). The court ruled firmly in favor of veterans:
The Ingram Ruling:
- ✓VA must disregard the beneficial effects of medication when rating musculoskeletal conditions
- ✓The Board must assess the veteran's "baseline severity" without medication
- ✓If the record lacks this information, claims must be sent back for new examinations
- ✓Failure to apply this standard is legal error
The court relied on the Jones precedent and extended it clearly to musculoskeletal conditions—affecting hundreds of thousands of veterans with back pain, knee problems, arthritis, and joint injuries.
The Appeal: What Happens Next
The Ingram v. Collins case has been appealed to the U.S. Court of Appeals for the Federal Circuit (Case No. 25-1972). This means the legal battle is ongoing.
Why This Matters: If the Federal Circuit upholds Ingram, it becomes binding precedent. If the VA issues a rule change, the legal landscape could shift. Either way, understanding your rights now is critical.
Where Things Stand Now (February 2026)
| Aspect | Before Ingram (Old Practice) | After Ingram (Current Law) |
|---|---|---|
| Medication Effects | Often considered by examiners | Must be disregarded |
| Rating Basis | Medicated state | Unmedicated baseline severity |
| C&P Exam | Evaluated as-is with meds | Must estimate severity without meds |
| Legal Status | VA interpretation | CAVC ruling (on appeal to Federal Circuit) |
Important Exceptions: When Medication IS Part of the Criteria
Some diagnostic codes explicitly include medication as part of the rating criteria. For these conditions, the need for medication actually helpsestablish severity:
Mental Health (PTSD, Depression, Anxiety)
- • 0%: No continuous medication needed
- • 10%: Symptoms controlled by continuous medication
- • Higher ratings consider medication effectiveness
Hypertension (DC 7101)
- • 10%: Requires continuous medication for control
- • Medication requirement helps prove severity
Asthma (DC 6602)
- • All rating levels mention medication type
- • 10%: Intermittent bronchodilator therapy
- • 100%: Daily high-dose corticosteroids
Fibromyalgia (DC 5025)
- • 10%: "Requires continuous medication for control"
- • Medication is explicit criteria
What You Should Do NOW
Whether you're filing a new claim, seeking an increase, or preparing for a C&P exam, here's how to navigate this uncertain landscape:
1. Document Everything About Your Medication
Evidence That Wins
- ✓List ALL medications you take for each service-connected condition
- ✓Note when you last took each medication before any exam
- ✓Describe your symptoms when medication wears off or you miss a dose
- ✓Keep a symptom diary showing 'good days' vs 'bad days'
- ✓Get statements from spouse/family about your unmedicated state
2. Describe Both States at Your C&P Exam
Under the Ingram ruling, you should describe your full situation, especially your unmedicated state:
- Current state: How you function with medication
- Baseline state: How you function when medication wears off
- Flare-ups: Your worst days, even with medication
- Side effects: Problems caused by the medication itself
3. Claim Medication Side Effects Separately
Regardless of how medication effects are treated for your primary condition, you can always claim secondary conditions caused by medication side effects:
Common Medication Side Effects to Claim:
NSAIDs (Ibuprofen, Naproxen):
- GERD / acid reflux
- Gastritis
- Kidney problems
Opioid Pain Medication:
- Constipation / IBS
- Sleep disturbances
- Cognitive impairment
Mental Health Medications (SSRIs):
- Erectile dysfunction
- Weight gain
- Sleep disorders
Steroids (Prednisone):
- Diabetes
- Osteoporosis
- Weight gain
4. If Your Condition Worsens, File for an Increase
If your medication stops working effectively or your condition deteriorates, you can file for an increased rating. Under Ingram, the VA should evaluate your unmedicated baseline—which supports higher ratings when medication fails.
5. Monitor the Appeal
The Ingram case is on appeal to the Federal Circuit. The outcome could solidify veterans' rights or the VA could respond with regulatory changes. Keep records and stay informed.
C&P Exam Tips Under Ingram
Your C&P exam is critical. Here's how to approach it under the current Ingram precedent:
Evidence That Loses
- ✗Only describing your best days with medication
- ✗Downplaying symptoms to seem 'tough'
- ✗Assuming the examiner knows your full history
- ✗Not mentioning flare-ups or when medication wears off
- ✗Failing to describe daily life limitations
Evidence That Wins
- ✓Describe your WORST days, not your best
- ✓Explain how you function when medication wears off
- ✓Detail flare-ups even when medicated
- ✓List specific activities you cannot do
- ✓Bring a symptom diary with entries over time
- ✓Have spouse/buddy statements ready
- ✓Mention all medication side effects
Legal References
Key Cases and Regulations:
- Ingram v. Collins, 38 Vet. App. 130 (2025) — Current ruling requiring VA to disregard medication effects for musculoskeletal conditions
- Jones v. Shinseki, 26 Vet. App. 56 (2012) — Established the "no medication consideration" principle
- McCarroll v. McDonald, 28 Vet. App. 267 (2016) — Clarified Jones application
- 38 CFR § 4.10 — VA regulation on functional impairment evaluation
- Federal Circuit Case No. 25-1972 — Pending appeal of Ingram decision
The Bottom Line
The Ingram v. Collins decision is a significant win for veterans—for now. The ruling is on appeal, and the VA may respond with regulatory changes. Use this opportunity.
Key Takeaways
- ✓Under Ingram, VA should rate you based on your unmedicated baseline severity
- ✓Document your symptoms when medication wears off—this is now critical evidence
- ✓Describe flare-ups and worst days at your C&P exam
- ✓File claims for medication SIDE EFFECTS as secondary conditions
- ✓The case is on appeal to the Federal Circuit—the law may change, so act now
- ✓Some conditions (PTSD, asthma, hypertension) explicitly consider medication in rating criteria—use this to your advantage
This situation may evolve—through the Federal Circuit appeal, VA rulemaking, or future legislative action. In the meantime, document thoroughly, describe your unmedicated state clearly, and don't assume the VA will advocate for you.