Yes, in some cases, medications and treatments can affect your VA Disability Benefits.
Now, you may have heard horror stories of veterans losing their disability benefits after following their doctor’s orders, but while this is possible, these situations are actually rare.
There are circumstances where the treatment of your condition could lead to a decrease in benefits, but in others, the use of medications and treatments could actually increase your benefits.
Let’s dispel the myths running around the internet and discuss exactly how and when medications and treatments can affect your VA Disability Benefits so you can pursue your best health with confidence while getting the benefits you deserve.
How the VASRD Works
The intent of the VASRD is to rate every condition based on the resulting level of disability it causes, meaning how much it impacts the veteran’s ability to function at work and perform the tasks of daily living. The higher the rating, the more benefits received.
The VASRD was written by groups of lawyers and doctors who tried to create rating requirements for each condition that would ultimately reflect the resulting level of disability caused by the condition. To do this, they took into account the most up-to-date (at that time) medical understanding of the condition and its symptoms, functional impact, and treatments.
Some conditions are rated solely on their symptoms, like limited motion and pain. Others are rated based on the types of treatments it requires, like surgeries, medications, etc.
The VA rates conditions based on their history and current severity at the time you submit your claim.
Since conditions often improve or worsen over time, the VA may call you in for a re-evaluation of your condition every 2-5 years. If you do not attend the examination for re-evaluation, the VA can decrease or terminate your ratings.
The VA may not re-evaluate your condition if they have determined that it is permanent (like an amputation), if the condition has shown no significant changes in the past 5 years, or if you are over the age of 55 (in most cases).
During these exams, the VA evaluates the current severity of the condition, and your rating is then adjusted accordingly.
If the re-evaluation shows that your condition has improved and you no longer qualify for a higher rating, the VA could lower your rating. On the contrary, if the re-evaluation shows that your condition has worsened, then the VA will increase your rating.
It is only during the re-evaluations that the VA can lower your rating, however, if your condition has worsened, you do not have to wait to be summoned for a re-evaluation. Instead, you can submit a claim for an increased evaluation at any time.
How Medications Affect the Ratings
In 2012, the U.S. Court of Appeals for Veterans Claims made a very important ruling in the case of Jones v. Shinseki.
The Court determined that the VA could only consider the effect of medications if the rating requirements in the VASRD specifically mention medications in the diagnostic code. If not, then the condition could only be rated based on the symptoms present without medication.
The Court argued that since the experts who wrote the VASRD included the effects of medication in some of the rating requirements, they must have considered these effects for all of the conditions. Thus, if medications are not mentioned in a condition’s rating requirements, this must have been intentional and the ratings should be applied without considering medications. The Court further stated that if the experts did want medications to be considered, then they could rewrite the rating requirements accordingly.
Since 2012, the majority of the VASRD has been updated and this ruling taken into account. For some conditions, the updated rating requirements do now mention medications and treatments. For others, however, they still do not, thus confirming that the ratings for these conditions were always intended to be applied without considering the effects of medications.
When Can Medications and Treatments Lower VA Disability Ratings?
The most common reason the VA will lower a rating is if the condition has healed, whether partially or completely.
“Healed” in this case refers to conditions that have improved enough from medications and treatments that they are no longer needed.
For example, a condition that causes limited motion in the knee is rated 20% by the VA. Over time, physical therapy restores full painless motion in the knee. Upon re-evaluation, the VA discovers that the knee no longer has limited motion or pain and so lowers the rating to 0%.
The VA is legally justified in this action as the knee is solely rated on limited motion and pain. If the knee functions normally and medications are not needed to control the symptoms, then there is no disability that can be compensated.
If, however, the knee does regain full range of motion but still requires medications to control pain, then the VA will only lower the rating from 20% to 10%. Medications are not mentioned in the rating requirements, so without medications, the presence of pain would qualify the condition for a 10% rating.
The VA can lower ratings if your condition improves enough that it no longer meets the requirements for the higher rating. This can only happen through a re-evaluation and only as long as the lower rating is fully justified by the rating requirements.
For example, asthma that is so severe that it requires steroid injections 3 times a year is rated 60%. Over time, the asthma improves and now only requires the daily use of an inhaler. Once the VA notes this improvement upon re-evaluation, they lower the rating to 30% since a 60% rating is no longer supported.
Again, the decision to lower the rating is justified since the VA has to have evidence that the condition fully meets the rating requirements in order to award a higher rating.
The only other time the VA can lower your rating is if they discover fraudulent or misleading evidence in your case.
If your rating is lowered, the good news is that you can easily submit a claim at any time to have your rating increased if the condition worsens again in the future.
When Can Medications and Treatments Increase VA Disability Benefits?
There are two ways in which medications and treatments can increase your VA Disability Benefits.
First, if your condition worsens despite treatment and you now need more intensive medications and treatments, you could qualify for a higher rating.
For example, if your asthma only requires the daily use of an inhaler, it is rated 30%. If over time, the condition worsens and you now require steroid injections 3 times a year, you can apply for an increased evaluation and have your rating increased to 60%.
If your condition has worsened, you can find your condition on our site to see if you now meet the rating requirements for a higher rating. If so, you can submit a claim at any time for an increased evaluation along with medical records showing that you meet the higher rating requirements.
Second, many medications and treatments can cause side effects that result in conditions that can also be claimed and rated separately. Any condition caused by the treatment of one of your service-connected conditions qualifies for secondary service-connection.
Many medications can cause ratable side effects, like high blood pressure, headaches, liver damage, digestive issues, heart issues, and much more.
If you have developed a new condition as the result of your medications or treatments, then you can submit a new claim for these secondary conditions. You will need to submit proof of the cause of the condition in order to prove secondary connection.
In every secondary condition case, we suggest submitting a Nexus Letter from your physician clearly stating that the condition is “more likely than not” the result of the medication or treatment and no other cause. This will greatly strengthen your case.
What can you do if your rating is lowered?
If your rating was unjustly lowered, you can submit an appeal for reconsideration.
Along with the appeal, make sure to include evidence that your condition still meets the rating requirements for your previous rating. As long as you can provide this evidence, your rating should be restored.