The VA Medication Rule Was Rescinded: What Ingram v. Collins Means for Your Rating

In February 2026 the VA published a rule that would have rated your disability based on how you function while on medication, then rescinded it days later. The prior standard is back. For many conditions, the VA still cannot use the fact that medication controls your symptoms to hold your rating down. This is where things actually stand, because a lot of what is online froze at the wrong moment in the story.

The Short Version

• On February 17, 2026, the VA issued an interim final rule, "Evaluative Rating: Impact of Medication," that changed 38 C.F.R. § 4.10 to rate veterans as medicated.

• After heavy opposition, the VA halted enforcement on February 19 and formally rescinded the rule effective February 27, 2026, restoring the prior text.

• The rule is gone. The standard from Jones v. Shinseki and Ingram v. Collins applies again.

• Under that standard, for a condition whose rating criteria do not mention medication, your disability is generally evaluated as if you were not taking the medication.

• The legal question is not fully settled. Ingram is reported to be on appeal, and the VA could try new rulemaking later.

What Was the "Medication Rule"?

On February 17, 2026, the VA published an interim final rule titled "Evaluative Rating: Impact of Medication" (91 Fed. Reg. 7118). It amended 38 C.F.R. § 4.10, the regulation that governs how the VA measures functional impairment. In plain terms, the rule said examiners would not estimate or discount improvements from medication or treatment, whether or not the rating criteria mentioned medication. If your medication lowered your level of disability, your rating would be based on that lowered level.

The VA framed this as clarifying its longstanding policy. Veterans groups saw it very differently: a change that could penalize veterans for taking prescribed treatment and could lower ratings for millions. The rule drew fierce opposition and more than 20,000 public comments.

Wait, Is It Still in Effect?

No. This is the part that a lot of articles get wrong, because they stopped following the story too early. Here is the full sequence:

The medication rule, start to finish

If you find an article that says the rule is active, or "halted but not rescinded," check the date. It is almost certainly from before February 27, 2026.

The Standard That Came Back: Jones and Ingram

With the rule gone, the case law that protects veterans is back in force. Two decisions matter most.

Jones v. Shinseki, 26 Vet. App. 56 (2012). The Court of Appeals for Veterans Claims held that when a diagnostic code's rating criteria do not mention the effects of medication, the VA cannot deny a higher rating just because medication is working. The reasoning was simple: the VA should not treat medication as a rating factor when the criteria never listed it as one.

Ingram v. Collins, 38 Vet. App. 130 (2025). Decided in March 2025, this case extended Jones to musculoskeletal conditions rated on limitation of motion. The Board had denied higher ratings while the veteran was taking prescription pain medication. The court held the Board erred by not discounting the beneficial effects of that medication, and that if the record does not show the disability's baseline severity without medication, the claim must go back so the VA can develop that evidence (Ingram, 38 Vet. App. at 137–39).

What This Means for Your Rating

For a condition whose rating criteria do not mention medication, the VA generally must evaluate your disability as it would be without the ameliorative effects of your medication. Well-controlled does not mean not disabling, and a controlled symptom is not supposed to translate into a lower rating when the criteria never accounted for treatment.

There is an important limit. Some diagnostic codes do account for medication. For example, certain criteria turn on whether a condition requires continuous medication for control. Where the criteria build in medication like that, medication is properly considered, and the Jones and Ingram protection does not remove it. The protection is strongest where the criteria say nothing about medication at all.

Why It Matters Most for Musculoskeletal Claims

Ingram was a musculoskeletal case, and that is where this issue comes up constantly. Joint and spine conditions are usually rated on range of motion and functional loss, and the criteria do not mention pain medication. So if you take something for knee, back, shoulder, or hip pain, the examiner is generally supposed to consider how the joint functions apart from that relief, including painful motion, weakness, and the added loss during flare-ups and repeated use.

In practice, this often does not happen on its own. A C&P exam frequently captures your best moment, on medication, on a good day. That is exactly the gap a clear medical record can close.

Can I Ask My Examiner to Rate Me Without Medication?

This is one of the most common questions veterans have after learning about Ingram, and the instinct is right. You want the exam to capture how disabling your condition really is, not just how you look on a good day with your medication working. You cannot control what the examiner writes, but you can make sure the record reflects your unmedicated severity. Here is how.

• Disclose every medication you take, and tell the examiner what you took that day. The examiner needs to know medication is in the picture before they can account for it.

• Describe the condition without the medication's help, from your own experience. What is it like first thing in the morning, when a dose wears off, or before you started treatment? Be concrete: "the medication takes the pain from unbearable to manageable, but I still cannot lift more than fifteen pounds or stand for more than twenty minutes."

• Describe flare-ups and repeated use. For joints and the spine, the examiner must give an opinion on your functional loss during flare-ups and with repeated use, based on your history, even if they do not see a flare-up in the room (Sharp v. Shulkin, 29 Vet. App. 26 (2017); DeLuca v. Brown, 8 Vet. App. 202 (1995)). Do not answer "no" when asked about flare-ups if you have them.

• Do not skip doses or stop your medication to "prove" how bad it gets. That is unsafe, and it is not necessary. Describing your experience and getting it documented does the job.

If the exam still only captures your medicated, best-moment picture, that can be a problem. For a condition whose criteria do not mention medication, an exam that credits the relief your medication provides, or never addresses your unmedicated baseline, may be inadequate. When that happens, you can point it out in a written statement, request a new exam, or submit a private opinion that documents the baseline the exam missed. (For more on answering a weak or one-sided exam, see our guide on rebutting a C&P opinion.)

How to Document Your Unmedicated Baseline

You cannot, and should not, stop taking prescribed medication to "show" the VA how bad it gets. The answer is documentation, not going without treatment. A strong record does a few things:

• Describes the condition apart from the relief medication provides, so the underlying severity is on the record.

• Captures flare-ups and repeated use, including range of motion, pain, weakness, and functional loss when the condition is at its worst.

• Uses the right rating language, tying your limitations to the measurements the diagnostic code actually uses.

• Notes whether the criteria mention medication, so the argument is aimed correctly.

A clinician-completed Disability Benefits Questionnaire (DBQ) or medical opinion is built to do this. It documents the functional impairment the condition causes, so a controlled symptom is not mistaken for a resolved one.

Is This Settled?

Not entirely, and it would be a mistake to say otherwise. The rescission notice itself states that it does not resolve the legal questions now before the courts; it simply restores the prior regulatory text to keep things stable. Ingram v. Collins is reported to be on appeal to the U.S. Court of Appeals for the Federal Circuit, and the VA could attempt a new rule through the normal notice-and-comment process later on.

What that means for you: right now, the pre-February 2026 standard applies, and it favors veterans on conditions whose criteria are silent about medication. But this is a moving area, so if your claim turns on this issue, it is worth confirming the current state of the law when you file.

Frequently Asked Questions

References

1. 38 C.F.R. § 4.10 (functional impairment) and 38 C.F.R. § 3.105 (due process for rating reductions).

2. Jones v. Shinseki, 26 Vet. App. 56 (2012) (VA may not deny a higher rating based on the ameliorative effects of medication where the diagnostic code does not contemplate medication).

3. Ingram v. Collins, 38 Vet. App. 130, 137–39 (2025) (extending Jones to musculoskeletal conditions; remand required where the record does not show baseline severity without medication).

4. Interim Final Rule, "Evaluative Rating: Impact of Medication," 91 Fed. Reg. 7118 (Feb. 17, 2026) (RIN 2900-AS49).

5. Rescission of Interim Final Rule, "Evaluative Rating: Impact of Medication," 91 Fed. Reg. 9712 (Feb. 27, 2026) (restoring prior regulatory text; noting the action does not resolve the legal questions before the courts).