Veterans taking medication for their service-connected disability may be concerned they will lose their VA benefits if medicine improves their condition. However, unless medication is mentioned in the Schedule of Ratings under the condition’s diagnostic code, the VA may not consider the beneficial effect of a veteran’s medication in assigning a rating.
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In this article about VA disability and medication:
Medication can play a critical role in helping veterans alleviate the symptoms of their service-connected disabilities. However, some veterans may be concerned that if the medication works well, they may no longer qualify for benefits or a certain disability rating.
That’s a valid concern that made it to the U.S. Court of Appeals for Veterans Claims (CAVC). In 2012, the CAVC ruled in the case of Jones v. Shinseki that the VA must rate a veteran’s disability without including the effects of medication unless the Schedule of Ratings explicitly mentioned medicine in the diagnostic code for the condition.
Do I qualify for VA benefits if medication improves my condition?
If the diagnostic code for your condition does not mention medication, and–with or without it–you meet the criteria outlined in the Schedule of Ratings for benefits for your service-connected disability, you will qualify for those benefits.
In the Jones v. Shinseki case, Jones suffered from irritable bowel syndrome (IBS). It appeared to him that he met the criteria for a 30% rating, but the VA denied his request for an increase from 10%. In the decision, the Board of Veterans’ Appeals (BVA) mentioned that “anti-acid medication provided some relief of symptoms.”
In the appeal decision, the CAVC explained that within the Schedule of Ratings, the criteria for rating some disabilities includes a mention of medication. The fact that some diagnostic codes do include standards regarding the effects of medication, but others don’t, is on purpose. If an executive department wants to add language about medication to other diagnostic codes, it may. But, until then, the VA cannot deny higher ratings based on relief from medications if the code doesn’t mention medication.
Will I lose VA benefits if medicine improves my condition?
A veteran will continue to qualify for VA benefits regardless of any alleviating affects of medication on their condition as long as the diagnostic code for the condition does not specifically mention medication and the veteran otherwise meets the criteria to receive benefits for the disability.
The VA does have the option to reevaluate disabilities every 2 to 5 years and assign updated ratings. Veterans may see a loss or decrease in VA benefits if the condition (without taking into consideration the beneficial effects of medication) improves.
There are some cases in which the VA is not likely to reevaluate veterans’ health conditions or reduce or remove their benefits. Disabilities labeled as static, stable, or permanent are usually not scheduled for reexamination, nor are disabilities rated at the minimum. Also, veterans over the age of 55 are rarely sent for reexaminations.
Medication can be a factor if mentioned in the Schedule of Ratings
Several conditions listed in the Schedule of Ratings list medication use in their rating criteria. For many of these conditions, the need for medication helps to demonstrate the severity of the disability. The following is an incomplete list of examples of when the VA can consider the effects of medication when assigning a disability rating.
PTSD rating with medication
Unfortunately, post-traumatic stress disorder (PTSD) is a common diagnosis among veterans. At the end of 2021, 1.2 million veterans received VA benefits for PTSD. Medication plays an essential role in controlling the symptoms of PTSD and other mental disorders.
The VA factors medication into the general rating formula for mental disorders to provide a rating for PTSD. The schedule states a veteran with a formal diagnosis and symptoms that “are not severe enough either to interfere with occupational and social functioning or to require continuous medication” will receive a 0% rating.
For a 10% rating, the schedule states a veteran must experience “occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.” The criteria for higher ratings for mental disorders do not mention medication.
Fibromyalgia rating with medication
Veterans with fibromyalgia experience pain all over their bodies. The condition often comes with sleep issues, headache, fatigue, irritable bowel syndrome, and mental distress. The VA rates fibromyalgia under diagnostic code 5025. In the criteria, a 10% rating is set for symptoms that “require continuous medication for control.” The requirements for higher ratings do not mention medication.
Asthma rating with medication
Asthma, which often requires medication, is rated under diagnostic code 6602. The VA rates asthma between 10% and 100%, and every criteria level mentions medication use. The levels range from daily use of high-dose corticosteroids or immuno-suppressive medications to intermittent inhalational or oral bronchodilator therapy.
Heart disease rating with medication
The general rating formula for heart disease also mentions medication in the lowest rating of 10%. It is explained as “continuous medication required for control.”
Hypertension rating with medication
The VA rates hypertensive vascular disease under diagnostic code 7101. The lowest rating for the condition is 10%, and it lists “minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control” as one of the reasons for being given the rating.
Hyperparathyroidism rating with medication
Hyperparathyroidism is rated under diagnostic code 7904. Veterans who have symptoms despite surgery or aren’t candidates for surgery but require continuous medication to manage their condition are rated at 10%.
Glaucoma rating with medication
The VA rates angle-closure glaucoma under diagnostic code 6012 and open-angle glaucoma under diagnostic code 6013. These ratings also reference the general rating formula for diseases of the eye. The codes state that if continuous medication is required, the VA will give the minimum rating of 10%.
Side effects of medication and VA benefits
Many medications, and treatments for health conditions, come with the risk of side effects. Symptoms can range from short-term nausea and headaches to long-term impacts on internal organs.
If you are dealing with side effects from medication or treatment for a service-connected health condition or are experiencing side effects from the medication you took during military service, you may be eligible for VA benefits for these conditions.
“They did good by me. I am sick, and the VA was stalling. They got me 100% permanent and total.”
R.W.
Hiring a VA-accredited lawyer
Navigating the rules about how medications affect VA benefits and figuring out if your rating decision applied the rules correctly can be challenging. It could be helpful to have an accredited VA disability lawyer take a second look.
Woods and Woods has helped thousands of veterans across the country receive the VA benefits they deserve. Call today or fill out our online contact form to get started.
Talk to Us About Your Claim:
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FREQUENTLY ASKED QUESTIONS
If the diagnostic code for a condition does not mention medication, and–with or without it–a veteran currently meets the criteria outlined in the Schedule of Ratings to receive benefits for the disability, the veteran will continue to qualify for VA benefits.
No. If you need continuous medication to control your symptoms of heart disease, you will receive a rating of at least 10%.
