Veterans and advocates are struggling to understand the ramifications of a new federal rule, under which the Department of Veterans Affairs will consider the effectiveness of medications when assigning disability ratings.
“If medication or treatment lowers the level of disability, the rating will be based on that lowered disability level,” according to the new VA rule published in the Federal Register that went into effect on Tuesday.
In separate statements, officials with the Veterans of Foreign Wars called the rule change an “abrupt shift,” and Disabled American Veterans said it was “issued in a closed and unnecessarily expedited process.”
“There’s been no communication between any of us,” said Andrew Tangen, president of the National Association of County Veterans Service Officers. “If there had been, we would have been able to tell the VA that this has far-reaching implications of what they’re thinking about, especially in the realm of post-traumatic stress, for example.”
VA spokesman Pete Kasperowicz said that the new rule formalizes a longstanding practice and that the latest action “will have no impact on any veteran’s current disability rating.”
However, the VA’s statement is at odds with what prominent veterans groups have said. Officials with the Veterans of Foreign Wars, or VFW, and Disabled American Veterans, or DAV, told Task & Purpose that the rule could result in veterans who take medications for a range of injuries and illnesses having their disability ratings reduced.
A VA social worker also told Task & Purpose the rule came by “complete surprise,” adding that the policy would be “disastrous” for veteran mental health if patients’ ratings are downgraded when they have their periodic reevaluation.
“That could drop their service connection level below what would qualify them for VA benefits, such as full prescription coverage,” they said.
Tangen gave an example of a veteran with suicidal ideation and multiple past suicide attempts who is rated at 100% permanent total disability — meaning their condition is not expected to improve and prevents them from being fully employed. Under the new rule, that veteran could be rated closer to 30% if symptoms showed improvement with medication.
“You have somebody who should be 100% permanent total, potentially not working, rated at 30% for post-traumatic stress because of medication,” he said. “The VA pharmacy, which has happened before, misses an automatic refill, and then a veteran has to go through withdrawal symptoms for two weeks on post-traumatic stress because they’re not on their medications. And unfortunately, we know for a fact that that has resulted in veteran suicide in the past.”
The rule change appeared to catch many veterans and advocates off guard. Army photo by Sgt. Aiden O’Marra.
Paralyzed Veterans of America also has “serious questions” about the VA’s new rule, said Carl Blake, the group’s chief executive officer.
“Treatment to alleviate symptoms of a service-connected condition, including medication, should not be used in a way that decreases compensation for that disability,” Blake said in a statement. “Such a notion could set up a slippery slope where a veteran with a spinal cord injury could be considered less disabled simply because he or she is able to use a wheelchair to ambulate.”
Michael Figlioli, the national service director for VFW, told Task & Purpose that by tying disability ratings to medication or treatment, it could cause some veterans to avoid seeking that kind of care, lest they see their compensation affected.
American Legion’s national commander, Dan K. Wiley, issued a statement on Wednesday saying that the VA did not give veterans an opportunity to weigh in before the rule took effect.
“Veterans should not be penalized for complying with treatment,” Wiley said. “Even if such treatment shows improvement in symptoms, the underlying disability does not disappear.”
As of Wednesday afternoon, the rule had more than 650 public comments, many from veterans who chimed in with similar worries and others who said it creates a “perverse” incentive for veterans to avoid receiving medication or treatment.
Top Stories This Week
House Veteran Affairs Committee ranking member Rep. Mark Takano (D-Calif.) issued a statement on Wednesday with similar criticisms.
“VA is once again leaving the veterans’ community out of a critical decision-making process and ignoring judicial precedent as it takes steps to scale back veterans’ benefits,” Takano said. “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.”
Sen. Richard Blumenthal (D-Conn.) also slammed the VA’s new rule on Wednesday, saying it “appears ripped straight out of Project 2025,” in reference to a series of policy recommendations issued by the Heritage Foundation think tank in 2024.
“The Court of Appeals for Veterans Claims recently ruled that a veteran’s disability rating must be based on their worst day,” Blumenthal, the ranking member on the Senate Veterans Affairs Committee, said in a statement. “That is how VA should accurately assess the true extent of a veteran’s condition. This new administration policy will do nothing but reduce the compensation veterans are due, and scare them into avoiding the life-improving medication they need – thereby posing an imminent risk to veterans’ physical and mental health.”
New rule heightens fears about broader VA benefit cuts
The move by the VA comes as calls to rein in veterans’ disability benefits have grown louder in recent years, including a 2024 opinion article in The Economist that described such benefits as “absurdly generous” and a Washington Post article in October that claimed that the disability claims process was “prone to rampant exaggeration and fraud.”
Michael Embrich, a Navy veteran who previously worked at the VA, said this rule “reinforces” concerns that he and other veterans had around Project 2025 proposals, which included “de-rating” veterans — taking away their disability ratings completely.
The Project 2025 proposal was created by a conservative think tank and has been rebuffed by current Trump administration officials. But several recommended reforms have been implemented across federal agencies and in the VA, like phasing out healthcare for transgender veterans. The policy document brings up “historic increases in mandatory” costs in VA disability spending and calls for the agency to “target significant cost savings from revising disability rating awards for future claimants while preserving them fully or partially for existing claimants.”
The Federal Register notice states that allowing VA evaluators to interpret disability ratings without considering the effects of medication on a veteran’s injury or illness would “generate considerable administrative costs” and lead to an “overall increase in compensation expenditures.”
Embrich, who has service-connected tinnitus, said he currently takes medication to manage his symptoms, but it’s not a cure.
“I used to wake up in the middle of the night from it. Now, is the medication that my neurologist gave me making it better? Yeah, but it never goes away,” he said. “I don’t understand how somebody would be able to take my rating away because of that. It doesn’t make any sense.”
Questions still linger about how, exactly, ratings will work under the new policy. Army National Guard photo by Spc. Tristin Salisbury.
In the Federal Register notice, the VA said that the new rule was needed because a recent appeals case would require more than 350,000 pending claims to be readjudicated. In that case, the court ruled that the VA must “discount beneficial medication effects” when determining a disability rating. The matter is currently pending before the U.S. Court of Appeals for the Federal Circuit.
But Tangen said veterans could see their disability ratings lowered when they have their ratings reevaluated, which occurs every two-to-five years, depending on the health condition.
“With this final rule, they’re telling [Compensation and Pension] examiners to not look at the totality of the medical evidence but look at what the veteran looks like on these medications,” Tangen said. “That runs the risk of potentially substantially more than the 350,000 identified having rating reevaluated and being reduced.”
‘20 steps back from what we fought for’
The consequences of the rule could also harm veterans who are dealing with “progressive and unpredictable” illnesses, like those covered under the Promise to Address Comprehensive Toxics Act, also known as the PACT Act, officials with Burn Pits 360 said in a release. These common toxic-exposure related health ailments include cancers, cardiovascular and chronic inflammatory conditions, and neurological and immune-related illnesses.
Under the PACT Act, veterans with certain conditions or illnesses due to toxic exposure can receive a 100% temporary disability rating. It’s unclear whether the recent rule change will impact those kinds of temporary ratings.
“What it implies is that VA may rate based on that improved appearance instead of untreated severity,” said Rosie Torres, co-founder of Burn Pits 360. “VA could evaluate based on the treated state rather than the worst untreated impact.”
Many veterans who are suffering from ailments caused by toxic exposures have to take medications to manage their conditions, including cancer, Torres told Task & Purpose.
Get Task & Purpose in your inbox
Sign up for Task & Purpose Today to get the latest in military news each morning.
Sign Up
Torres said she is concerned that veterans may now be evaluated for disability ratings when their symptoms have temporarily subsided due to their medications.
“To even think about the fact that they would base a rating off of a one-time visit, where the veteran might have just used their nebulizer to help control or open up the airways — which have been burned, they’re desensitized, they no longer work — is just really an injustice,” Torres said. “You’re going to base that off of the fact that they had one good day.”
She added that although medicine can help veterans manage symptoms, they can’t “change the fact that you have an underlying lung disease that has no cure.”
“This is like taking 20 steps back from what we fought for,” Torres said. “We didn’t sleep on the steps of the Capitol those five nights to go back to where we started. I really, truly hope this administration understands the horrific error they’re considering by even considering this type of rating rule.”
Task & Purpose Video
Each week on Tuesdays and Fridays our team will bring you analysis of military tech, tactics, and doctrine.
Patty is a senior reporter for Task & Purpose. She’s reported on the military for five years, embedding with the National Guard during a hurricane and covering Guantanamo Bay legal proceedings for an alleged al Qaeda commander.
Jeff Schogol is the senior Pentagon reporter for Task & Purpose. He has covered the military for nearly 20 years. Email him at [email protected] or direct message @JSchogol73030 on Twitter.
