š A Major Shift in VA Disability Ratings
The landscape of VA disability ratings for musculoskeletal conditions has just undergone a significant earthquake. A recent change to 38 CFR 4.10 has effectively nullified the precedent set by the court case Ingram v. Collins. For years, veterans and raters have navigated the complex, often confusing, requirements of Ingram. Now, the VA is hitting the reset button.
If you're a veteran with a service-connected musculoskeletal condition, you might be wondering: What does this mean for me? Does this help or hurt my claim? This article will break down the entire story—from the pre-Ingram era to its brief and problematic reign, and what the new reality under 38 CFR 4.10 looks like for you and your future C&P exams.
Unified & Simple: How VA Ratings Worked Before Ingram
To understand where we're going, we must first understand where we've been. Before the Ingram v. Collins ruling, the VA's approach to rating disabilities was remarkably consistent across the board. The VA evaluates disabilities across 15 distinct body systems (e.g., cardiovascular, neurological, musculoskeletal). For decades, all 15 systems were evaluated under the same fundamental principle.
The core principle was simple: a veteran's disability rating was based on how they presented at the time of their Compensation and Pension (C&P) exam. š An examiner would measure your range of motion, observe your functional limitations, and document their findings. Those objective findings, combined with other evidence in your file, formed the basis of your rating. Medication was a part of your treatment record, but it didn't trigger a hypothetical evaluation. The question was, "How is the veteran's condition today?" not "How might it be under different circumstances?" This created a unified, predictable system for veterans and raters alike.
The Ingram v. Collins Interruption: A Noble Idea with Flawed Execution
The Ingram v. Collins ruling was born from a well-intentioned concept: veterans should not be penalized for effectively managing their conditions with medication. The ruling specifically targeted the musculoskeletal system and introduced a radical new requirement. It mandated that examiners look beyond the veteran's presentation at the exam and consider a hypothetical scenario: What would the veteran's range of motion and functional loss be if they were not taking their prescribed medications?
š” The Principle: "Medication Not a Penalty"
The goal was to ensure a veteran taking pain medication or muscle relaxants, which might temporarily improve their range of motion during an exam, would still receive a rating that reflected the true severity of their underlying condition. On paper, it sounded like a major win for veterans.
However, this new directive created a massive rift. Suddenly, 14 body systems were rated based on present-day reality, while one—the musculoskeletal system—was to be rated based on a speculative future or alternative reality. This well-meaning change, unfortunately, paved the way for significant problems in practice.
The Achilles' Heel: Why Very Few Veterans Benefited from Ingram
Despite the promise of fairer evaluations, the video evidence and anecdotal reports are clear: very few veterans actually won an increased rating or a favorable adjustment due to Ingram v. Collins. The success rate was incredibly low, and the reasons are rooted in two critical flaws in its application.
1. The Objective Evidence Trap ė«
The biggest hurdle was the requirement for objective evidence. To get an Ingram adjustment, a veteran couldn't just say, "My back hurts more without my pills." They had to show, with factual evidence, what their range of motion would be like off their medication. This created an impossible Catch-22. If a veteran was compliant with their doctor's orders and consistently took their medication, they would never have medical evidence documenting their condition without it. To get the evidence, they would have to stop their medication, potentially harming their health and well-being—something no responsible medical professional would advise.
2. The "Speculation" Escape Hatch šŖ
The second flaw was a clause that essentially gave examiners an easy way out. The ruling stated that if determining a veteran's condition off-medication was "mere speculation," the examiner was not required to do so. This was a critical loophole. Faced with the difficult, if not impossible, task of guessing a patient's range of motion without any data, what did most examiners do?
ā ļø The Examiner's "Out"
Examiners could simply answer "No" to the question of whether they could determine the veteran's condition without speculation. They didn't have to guess or extrapolate. By answering "no," the entire Ingram v. Collins framework was dismissed for that veteran's claim, and the evaluation defaulted back to the standard pre-Ingram method: rating based on how the veteran presented at the exam. This single clause rendered the ruling toothless in the vast majority of cases.
Back to Basics: How the New 38 CFR 4.10 Resets the Rules
Recognizing the failure and complexity of the Ingram experiment, the VA has taken decisive action. The change to 38 CFR 4.10 effectively nullifies Ingram v. Collins. The era of speculation is over.
The new regulation simplifies the process by returning to the original, unified standard. For musculoskeletal conditions, the VA will no longer make special considerations based on medication. The official reasoning stated in the Federal Register is that it is "impossible for us to gauge that"—a direct acknowledgment of the speculation problem. Furthermore, the VA expressed that it did not want to retrain its examiners to speculate.
So, what's the primary change? Musculoskeletal ratings will revert to being based on how the veteran presents at the time of the examination, regardless of medication. This change brings the musculoskeletal system back into alignment with the other 14 body systems, restoring a consistent and logical standard across all VA disability claims.
Navigating Your Next C&P Exam: What Veterans Need to Know Now ā
This change simplifies the process, but it's crucial to understand how to approach your C&P exams moving forward. Your strategy should now be laser-focused on the here and now.
Focus on Your Exam Day Presentation
How you feel and function on the day of your exam is now more important than ever for musculoskeletal claims. Be honest and thorough in describing your pain, limitations, and how your condition affects your daily life. The examiner's objective measurements of your range of motion during that appointment will be a primary driver of your rating.
Don't Forget Flare-Ups!
While the medication speculation is gone, the importance of flare-ups remains. The assessment of flare-ups, governed by a different court case (*Deluca v. Brown*), is a separate but vital part of the evaluation. It's crucial to distinguish this from the *Ingram* rule.
Understanding Flare-Up Assessment
A flare-up evaluation isn't just about how you are today. It's a conversation about the history and future of your condition. Be prepared to discuss:
- Frequency: How often do your flare-ups occur?
- Duration: How long do they last?
- Severity: What are your limitations during a flare-up? Can you work? Can you perform daily activities?
This part of the exam is about projecting your functional loss over time, and it remains a critical path to a higher rating that accurately reflects your disability.
The Role of Raters and Filtering
It's also helpful to understand that examiners and raters have always played a role in interpreting information. They "filter" or "dial in" the information provided by a veteran against the objective evidence. For example, if a veteran claims to have 30 debilitating migraines a month, the rater will look for corresponding evidence like medical records, prescriptions, and work absences to substantiate that claim. The new rule simplifies this filtering process for musculoskeletal claims by removing the impossible task of speculating about medication effects.
Key Takeaways for Veterans
This regulatory change may seem complex, but the outcome is a simpler, more predictable system. Let's summarize the most important points:
- Ingram v. Collins is Over: The rule requiring examiners to speculate about your condition without medication is no longer in effect for musculoskeletal claims.
- Presentation is Paramount: Your rating will be based on the objective findings and your functional limitations observed during your C&P exam.
- Medication is Not a Factor for Speculation: The VA has returned to the standard where medication use doesn't trigger a hypothetical adjustment to your range of motion.
- Flare-Ups Still Matter: Continue to thoroughly document and discuss your flare-ups, as this remains a separate and crucial element of your overall evaluation.
- System-Wide Consistency: The musculoskeletal system is now rated just like the other 14 body systems, restoring a unified standard.
Ultimately, this change removes a confusing and largely ineffective layer of bureaucracy from the claims process. By understanding this new reality, you can better prepare for your C&P exams and advocate for the rating you rightfully deserve. Stay informed, be prepared, and focus on clearly communicating the current impact of your service-connected conditions.