The short answer . . . it depends on the condition.
When the VA finds that a condition is related to service, the VA will issue a “rating” for that condition. The “rating” is based on the severity of the condition and corresponds with the amount of monthly compensation the veteran will receive. In other words, the worse the condition, the higher the rating, the higher the monthly payment.
The VA determines the severity of a condition by reviewing medical records and scheduling veterans for an examination. Of course, the severity of a condition can vary widely based on whether a veteran is taking medication.
For example, using insulin can be the difference between life and death for a veteran. Corticosteroid creams can keep a skin condition at bay. Pain killers can help a veteran walk to work. A c-pap machine can provide the relief of sleep where someone with sleep apnea may not otherwise find it. Using medication is a wonderful tool to improve any service-connected condition.
But could the improvements caused by medications equate to a lower rating?
Should veterans stop taking medication before an examination to get an accurate rating?
The answer to both of these is NO.
Veterans are always encouraged to take their prescribed medication, even when participating in a VA examination. But, in order to avoid medications skewing a rating, veterans must understand two things about how the VA handles medications when making decisions about the severity of a condition.
First, whether the VA considers the impacts of medication depends on the VA’s rating criteria for that condition.
Every service-connected medical condition corresponds to a condition listed in the VA’s Rating Schedule, which can be found here: VA Rating Schedule. For each condition, the VA lays out the criteria for each rating. Here are two examples for diabetes and limitation of flexion of the leg:
Diabetes mellitus (Diagnostic Code 7913):
| Symptoms | Rating |
|---|---|
| Requiring more than one daily injection of insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated | 100 |
| Requiring one or more daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated | 60 |
| Requiring one or more daily injection of insulin, restricted diet, and regulation of activities | 40 |
| Requiring one or more daily injection of insulin and restricted diet, or; oral hypoglycemic agent and restricted diet | 20 |
| Manageable by restricted diet only | 10 |
Limitation of flexion of the leg (Diagnostic Code 5260):
| Symptoms | Rating |
|---|---|
| Flexion limited to 15° | 30 |
| Flexion limited to 30° | 20 |
| Flexion limited to 45° | 10 |
| Flexion limited to 60° | 0 |
As you can see, the diabetes rating addresses medication use, but the limitation of flexion of the leg rating does not. When a rating addresses medication, it is ok for the VA to consider how bad the condition is after medication. In other words, because the diabetes rating includes mention of insulin medication, the VA will assess how severe the condition is after the medication.
However, when the rating criteria does not mention medication, the VA must consider how severe the condition is before medication. For example, consider a veteran who has limitation of flexion in the leg that prevents him from climbing the stairs, but when he takes pain killers, he can extend his flexion and walk up the stairs. In that case, because the rating criteria for flexion of the leg does not address medication, the VA must consider the severity of the condition without medication.
Thus, second, if a rating criterion does not address medication, the veteran must explain to the VA examiners and medical providers how severe the condition is without medication.
Often, the VA is tasked with assigning a rating for a veteran absent the impacts of medication, which can be tricky if the VA doesn’t know how bad the condition is without medication. The veteran is more likely to obtain a rating closer to the actual severity of the condition, if the veteran can document and explain to the VA the severity of the condition without medication.
Seeking Assistance
Trying to obtain the right rating for your service-connected condition can be complex, and it’s important to get it right. If you are unhappy with your ratings, Vets National can assist you in the appeal process. We understand the intricacies of VA claims, denials, and appeals and can help ensure your appeal is thorough and accurate.
Let Vets National help
Don’t let the complexity of VA appeals discourage you. At Vets National, we specialize in helping veterans like you navigate the VA disability appeal process.
Connect with us, at 877-777-4021, and let’s work together to help you get the benefits you deserve.
