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During the troop surge in Iraq, I learned to constantly scan for threats, how to distinguish the sharp crack of a gunshot pointed in my direction from one outgoing toward an enemy, and the myriad ways that explosives can be hidden on a roadside. I learned that hypervigilance can be the difference between life and death. What I didn’t learn was how to turn it off.
Now, I take three psychiatric medications every day, and I go to therapy every week. It’s taken a lot of work over the course of 15 years, but now I’m mostly functional. I raise my kids, go to work, and am part of my community. And I am among the nearly 5 million U.S. veterans who receive service-connected disability compensation, of whom roughly a quarter have a mental health condition such as post-traumatic stress disorder as their primary disability. That compensation is not charity, but compensation for harm incurred in service and a recognition that the government has a debt when the service it demands breaks bodies and minds.
But now, under a new interim rule issued by the U.S. Department of Veterans Affairs, the fact that medication helps me may also be used to reduce my disability compensation. The rule directs the VA to evaluate disabilities based on how veterans function with medication and treatment, rather than the underlying severity of their conditions. Essentially, if the pills work, good job staying alive; now move on without compensation for the inherent disability.
This issue was actually very recently litigated. Last year, the Court of Appeals for Veterans Claims decided Ingram v. Collins, a case that reaffirmed a rule first articulated in Jones v. Shinseki. The court was clear: When VA criteria for treatment do not explicitly mention medication-based improvements as a reason to discontinue disability benefits, the VA must discount the effects of medication and evaluate the disability as it would exist without treatment. That was not a radical interpretation but a straightforward application of the law. Treatment can mask symptoms, but it does not erase the harm. In response, the VA’s new rule asserts a blanket policy of considering the condition only as it presents under treatment, basically penalizing veterans like me for doing the work of staying alive.
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The consequences of this shift are not abstract. Peer-reviewed research and VA data show that disability compensation is directly linked to real-life stability for veterans with mental health conditions. A long-term study following veterans who applied for PTSD disability benefits found that those who received benefits experienced meaningful reductions in PTSD symptoms over a decade, compared with veterans who were denied. Those who received compensation were far less likely to experience poverty, with rates around 15 percent, compared to 45 percent among those denied benefits, and their risk of homelessness was nearly half that of denied veterans. Even years later, these differences in socioeconomic stability persisted, despite ongoing impairment. Compensation does not erase the injury, but it gives veterans the resources to manage it and live with it.
I know the stakes personally. The medication I take does not erase the injury. When I have stopped my medication, the symptoms have surged back. I have found myself back in the dark place where I think that I would have been better off if the IED with my name on it that I had always been scanning for had actually gone off and killed me. I have buried too many friends whose treatment worked until it didn’t. Their medications stabilized them, and their therapy helped them, but the underlying injury remained. Now they are dead by suicide.
This is why Ingram mattered. It recognized that improvement through treatment should not cancel out evidence of injury. Symptoms managed by medication are still symptoms, and the underlying disability remains. The VA’s interim rule rejects this principle, allowing improved function to justify rejection of disability status.
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The moral and legal logic of compensation is clear: It is not just about whether a veteran can work. It is about acknowledging permanent loss of quality of life that came as a result of their injuries. For example, in the civilian context, when construction workers fall off scaffolds and can’t walk until receiving surgery and physical therapy, their employers have to provide them workers’ compensation. It doesn’t matter if treatment can return them to full function and they can eventually return to work. The injuries occurred on the job, and the company has to provide compensation. “You break it, you buy it.” But for the Trump administration, despite its lavish spending on tax breaks for billionaires, military contracts, and Immigration and Customs Enforcement surges that are tearing the country apart, properly compensating veterans for sacrificing their well-being at the direction of the government is a waste of money that we don’t deserve.
The Trump administration’s interim rule fundamentally misunderstands both the law and the human cost of combat. Improvement does not equal cure, and functioning does not erase harm. VA disability compensation is not a paycheck. It is a recognition of veterans’ lives that will never be the same and a resource to help them pick up the pieces. The fact that symptoms can be controlled through daily maintenance medications is proof the injury is permanent and severe, not that medication can just make it go away. The law once recognized that distinction, and basic decency still should.
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