On February 17, 2026, the Department of Veterans Affairs published an interim final rule amending 38 CFR § 4.10 — the core regulation governing how VA disability ratings are evaluated.
As noted in the Federal Register notice, the rule takes effect immediately without input from Veterans, Veterans Service Organizations, or Congress.
As a medically retired Lieutenant Colonel with over thirty years of Army service—including combat deployments to Afghanistan and Iraq—I navigate the VA system not just as a professional, but as a Veteran with a 100% permanent and total disability rating. I share this personal background because the VA’s ruling on February 17, 2026, requires more than just a legal reading; it requires a practical understanding of how medical management affects a Veteran’s daily life. Based on this perspective, I am breaking down exactly what this new rule means for Veterans—beyond the regulatory text and into the reality of your claims.
What Does 38 CFR § 4.10 Do?
Here’s the mechanism of VA’s new rule on medication: under 38 CFR § 4.10, when a Veteran attends a Compensation and Pension (C&P) exam, the examiner will evaluate their disability based on how they function while using prescribed medications or other treatment, rather than how they might present without them.
Here are a few examples of how 38 CFR § 4.10 applies in practice:
• PTSD and Mental Health: If an antidepressant reduces PTSD symptoms to a manageable level, the Veteran will be rated based on that level of symptom control.
• Hypertension: If blood pressure medication keeps hypertension under control, the Veteran will be rated at that controlled level.
• Mobility Issues: If pain medication allows a Veteran to walk without a cane on most days, they will be rated for those days of improved function.
The rule states: “If medication or other treatment lowers the level of disability, the rating will be based on that lowered disability level.”
The Background of VA’s New Rule on Mediaction
Jones v. Shinseki (2012)
For over a decade, the Court of Appeals for Veterans Claims (CAVC) had built a body of case law protecting Veterans from exactly this kind of evaluation. In Jones v. Shinseki, 26 Vet. App. 56 (2012), the CAVC held that when a diagnostic code doesn’t specifically contemplate the ameliorative effects of medication, the Board of Veterans’ Appeals can’t deny a higher rating because medication was working. The court’s reasoning was straightforward: the VA shouldn’t be able to credit medication as a rating criterion when the diagnostic code never listed it as one. That was the law for thirteen years.
Ingram v. Collins (2025)
Then, in Ingram v. Collins, 38 Vet. App. 130 (2025), the CAVC extended Jones to musculoskeletal conditions, holding that examiners must estimate what the Veteran’s functional impairment would be without medication—even if that means speculation and the medical record doesn’t support the hypothetical. The VA opposed this, and understandably so. It created an unwieldy standard that required medical examiners to guess rather than observe.
How 38 CFR § 4.10 Affects New Claims and Appeals
The VA’s interim final rule went into effect on February 17, 2026, and applies to all pending claims and examinations from that date forward.
Impact on Pending Appeals
If a Veteran has a claim currently under appeal at the Board of Veterans’ Appeals or at the CAVC, the standard under which their case will be evaluated may have shifted. Appeals relying on the Jones or Ingram line of cases—arguing that the VA improperly considered the ameliorative effects of medication—now face a regulation that directly contradicts those precedents. The new rule effectively supersedes the case law that previously offered protection.
Impact on New Claims
For Veterans filing new claims, the implications are clear. Any claim filed today for PTSD, hypertension, musculoskeletal injuries, or other conditions managed by medication will be examined under the strict criteria of 38 CFR § 4.10. Ratings will reflect the Veteran’s condition after medication. The question of “what would this veteran’s condition look like without treatment?” is no longer part of the evaluation process.
Implications for 100% P&T and Schedular Ratings
Veterans holding a 100% Permanent and Total (P&T) disability rating often believe their status insulates them from regulatory changes. However, it is important to understand why this new rule may still be relevant.
A 100% P&T rating is not automatically static. If the VA schedules a future examination, which can occur under specific conditions, the reevaluation will now be conducted under this new medicated standard. Consequently, if a Veteran’s condition is well-managed by their treatment regimen, they could face a reduction proposal. In effect, the success of a Veteran’s medical treatment becomes a factor in re-evaluating their rating level.
Veterans with 100% schedular ratings — not P&T — are arguably at even greater risk. Any upcoming C&P exam and any proposed reduction will now be governed by this standard. The VA examiner won’t ask, “How bad would this Veteran be without medication?” Instead, they will evaluate the Veteran based on their presentation at the exam—medicated and functioning—and assign a rating accordingly.
The Procedural Shortcut, the Backlash, and the Legal Reality
The Procedural Shortcut for Implementing 38 CFR § 4.10
Rather than addressing Ingram through standard rulemaking—specifically the Administrative Procedure Act’s notice-and-comment process under 5 U.S.C. § 553—the agency invoked the “good cause” exception and published this rule as an interim final rule, effective February 17, 2026. This meant there was no public comment period and no input from Veterans. Secretary Doug Collins signed the rule on February 11, and it was active before most Veterans were aware of the change.
The VA argued that “good cause” for skipping public comment existed because delaying the rule would cause “significant disruption” to the claims system and increase costs by adjudicating claims “based on a disability level that Veterans are not actually experiencing.”
Widespread Opposition from Veterans Organizations and Congress
The reaction has been immediate and broad-based. The American Legion, the VFW, DAV, and members of Congress have all spoken out, raising objections that go beyond politics.
- American Legion National Commander Dan K. Wiley stated that veterans “should not be penalized for complying with treatment” and that “functional management is not total cure.” He noted: medication can help a Veteran sleep, reduce anxiety attacks, or lower vigilance — but it does not remove the underlying traumatic experience or moral injury.
- The Disabled American Veterans National Commander Coleman Nee went further, calling the rule “extremely disappointing and alarming,” noting it “could potentially reduce disability compensation for millions of disabled veterans” and that it “disregards clear decisions” from the CAVC — specifically naming Jones v. Shinseki and Ingram v. Collins by citation. He also noted that the rule affects more than 6 million Veterans currently receiving disability compensation, most of whom are taking at least one medication.
- House Committee on Veterans’ Affairs Ranking Member Mark Takano was direct: “This rule change penalizes veterans for taking medications to address their conditions and symptoms, putting veterans in a place of deciding between managing their health and receiving their full benefits.” He called on VA Secretary Collins to reverse the rule. VFW National Commander Carol Whitmore warned of “unforeseen and harmful downstream effects for veterans” and called for public scrutiny and possible legislative clarification.
- Michael Figlioli of the VFW said: “This is the first time VA placed their specific interpretation clearly into text. If there had been consistency in application since 1958, there would have been no need for repeated judicial clarification.”
Analyzing the VA’s Legal Argument from a VA-Accredited Attorney Perspective
To be fair, the VA’s legal argument is not without merit. The statutory basis for disability ratings under 38 U.S.C. § 1155 directs VA to compensate for “average impairments of earning capacity.” The VA argues, not unreasonably, that if a Veteran can work and function because of medication, the impairment on their earning capacity is reduced. The U.S. Court of Appeals for the Federal Circuit even noted in Nat’l Org. of Veterans’ Advocs., Inc. v. Sec’y of Veterans Affs., 927 F.3d 1263 (2019), that the VASRD is designed to compensate for the actual level of earning impairment.
That is a legitimate statutory argument. However, while the legal theory holds water, the practical application raises concerns.
Compensation is not intended to reward disability in isolation. It is intended to recognize that the underlying condition, the injury, the disease, the trauma, was caused or aggravated by military service. That foundation doesn’t disappear because a medication reduces the daily symptom load. A Veteran with service-connected PTSD who takes an SSRI and sleeps through the night is not cured. The trauma remains. Medication is a management tool, not a resolution.
And the day that medication is discontinued, by choice, by side effects, by availability, or by the VA’s own formulary, those symptoms return. Rating Veterans on a medicated baseline assumes the medication will always be available, effective, and appropriate. None of those assumptions is guaranteed.
The Category Nobody Is Talking About: Veterans Who Cannot Take Medication
There is a group that receives little attention in this conversation, yet they may be the most harmed: Veterans who have been advised by their medical providers not to take certain medications due to histories of addiction and alcoholism.
Under this rule, these Veterans face a difficult dilemma. Many dealing with PTSD, chronic pain, anxiety disorders, and depression are in recovery. Their treatment plans deliberately exclude opioids, benzodiazepines, certain antidepressants, and other controlled medications because the risk of relapse is real, documented, and potentially life-threatening.
These Veterans — sober, working their recovery, following their doctors’ orders — will present at a C&P exam with unmanaged symptoms not because they refused treatment, but because treatment was medically contraindicated. The VA’s new rule states they should be rated on their “actual functional impairment.” However, a challenge arises when a claims adjudicator reviews a file with severe symptoms and questions the lack of medication. The explanation— “because I am a recovering alcoholic and my doctor won’t prescribe it”—is not a defense that fits neatly into the new regulation.
The VA’s rule presupposes that medication is available, appropriate, and effective for every Veteran in every condition. It is not. For Veterans in recovery from substance abuse, demanding a medicated baseline as the rating standard is, at best, a blind spot in the rulemaking process. At worst, it creates an impossible choice: stay sober or keep your rating. That choice is not acceptable.
Where Does This Leave You?
If you are a Veteran with a VA disability rating currently managed with medication, you need to understand that this rule is real, in effect, and will be applied at your next C&P exam. If you are scheduled for a reevaluation or have a pending claim, this is not the time to wait and see.
The comment period closes April 20, 2026. Use it. Go to www.regulations.gov, search RIN 2900-AS49, and make your voice heard. The American Legion, VFW, and DAV are all engaged; find your VSO and support their advocacy efforts.
If you have a claim under appeal that relied on Jones or Ingram, the legal landscape under your feet just shifted. You need to talk to a lawyer for Veterans before your next hearing date, not after.
The Law Office of Will M. Helixon has VA-accredited attorneys ready to assist Veterans facing rating reductions, whose claims are currently under appeal, or who are dealing with new claims under this rule. We understand the VA system, the regulations, and the case law. We know what Jones and Ingram meant for Veterans, and we know what this interim final rule means now.
