The Veterans Compact Under Strain: What the VA Disability Controversy Reveals About America’s Promise to Its Service Members

IT'S TIME TO LOOK AT THE RELATIONSHIP BETWEEN THE NATION AND THE SERVICEPERSON

The recent controversy surrounding the Department of Veterans Affairs’ interim rule titled “Evaluative Rating: Impact of Medication” triggered a wave of backlash from veterans’ groups, policymakers, and the public. Although the VA quickly halted enforcement of the rule after the outcry, the episode exposed something far more significant than a technical regulatory dispute. It revealed a deeper conflict over what the United States owes those who serve in uniform and how the government defines compensation for sacrifice, injury, and lifelong loss.

At its core, the debate is not simply about disability ratings or medication. It is about the nature of the relationship between the nation and its service members — whether that relationship resembles an administrative insurance system or a moral covenant grounded in national obligation.

The Immediate Controversy: A “Clarification” That Sparked Outrage

The VA’s interim rule attempted to clarify how disability ratings should account for the effects of medication or treatment. The policy directed that disability evaluations should reflect a veteran’s actual level of functional impairment under ordinary conditions of life, including improvements resulting from medication. In practical terms, if treatment reduced symptoms or improved functioning, that improvement could lead to a lower disability rating.

The VA described this change as a technical clarification intended to resolve inconsistencies created by recent court rulings. Officials argued that disability compensation should reflect a veteran’s real-world functional capacity rather than a hypothetical untreated condition.

Veterans’ groups interpreted the rule very differently. They feared the policy would reduce disability ratings for conditions commonly controlled by medication, including chronic pain, post-traumatic stress disorder, migraines, and musculoskeletal injuries. Critics argued that the rule effectively penalized veterans for seeking treatment by treating symptom management as evidence of reduced disability, even when the underlying injury remained permanent.

The reaction was swift. The Secretary of Veterans Affairs halted enforcement of the rule, stating that although the department disagreed with how the policy had been characterized, it would not be implemented to alleviate veterans’ concerns. Yet the rapid retreat did not resolve the underlying issue. Instead, it exposed a larger institutional and philosophical conflict within the VA system itself.

The Legal Crisis Behind the Rule: 350,000 Claims in Limbo

The VA’s action did not arise in a vacuum. The department was responding to a series of court decisions that could dramatically alter how disability claims are evaluated. These cases stem from a legal question that may appear technical but carries enormous consequences: when a disability rating schedule does not explicitly mention medication, may the VA consider the relief provided by treatment when determining the severity of a condition?

Beginning with Jones v. Shinseki in 2012, federal veterans courts increasingly held that the VA may not deny higher disability ratings based on the effects of medication unless the rating criteria specifically allow it. More recent decisions expanded this reasoning, pushing toward a framework in which disability must be evaluated as if the veteran were not receiving treatment.

The VA warned that this interpretation could require re-adjudication of hundreds of thousands of pending claims and affect more than five hundred diagnostic categories. The department estimated that over 350,000 disability claims could be affected, potentially requiring new medical examinations and revised rating procedures. Officials argued that such changes would impose enormous administrative burdens, create delays, and force examiners to speculate about hypothetical untreated conditions.

The interim rule was intended to counter this judicial trend by asserting the VA’s authority to consider real-world functioning. Instead, it ignited fears that the department was attempting to reduce benefits system-wide under the guise of administrative clarification.

The Legal Framework Governing VA Disability Compensation

The conflict surrounding the VA’s medication rule cannot be understood without examining the statutory and judicial framework that governs disability compensation.

Federal law defines the purpose of VA disability ratings as compensation for “average impairment in earning capacity” resulting from service-connected conditions. This standard is established under 38 U.S.C. § 1155, which authorizes the VA to create a schedule of ratings based on functional impairment. The implementing regulation, 38 C.F.R. § 4.1, similarly states that disability ratings represent the average reduction in earning capacity resulting from disease or injury incurred in military service.

This framework reflects the system’s origins in early twentieth-century workers’ compensation models, which prioritize economic impairment and functional limitation rather than individualized damages.

However, judicial interpretation has increasingly challenged how the VA applies this standard when treatment affects symptoms.

The Line of Cases Creating the Current Crisis

In Jones v. Shinseki, 26 Vet. App. 56 (2012), the U.S. Court of Appeals for Veterans Claims held that the VA may not deny higher disability ratings based on the “ameliorative effects” of medication unless the applicable rating criteria explicitly contemplate such effects. The court reasoned that evaluating a disability based on symptom relief from medication could understate the underlying severity of the condition when the rating schedule does not authorize that consideration.

In McCarroll v. McDonald, 28 Vet. App. 267 (2016) (en banc), the court clarified that when rating criteria specifically reference medication, the VA may consider its effects. The decision reinforced the principle that the VA’s authority depends on the precise wording of each diagnostic code, creating inconsistencies across the rating system.

More recently, Ingram v. Collins, 38 Vet. App. 130 (2025), expanded the practical consequences of Jones by applying its reasoning to musculoskeletal disability ratings involving limitation of motion. The decision suggested that the VA may be required to assess the severity of certain conditions without accounting for treatment effects, potentially requiring medical examiners to estimate functional limitations absent medication.

The VA warned that this interpretation could require re-adjudication of over 350,000 pending claims and affect more than five hundred diagnostic codes across the disability rating schedule.

The Absence of Civil Liability: The Feres Doctrine

A central structural feature of the veterans’ compensation system is the absence of civil remedies for service-related injuries. Under Feres v. United States, 340 U.S. 135 (1950), the Supreme Court held that service members may not sue the federal government under the Federal Tort Claims Act for injuries incident to military service.

The Court justified this rule based on concerns about military discipline, command authority, and the existence of a comprehensive statutory compensation system.

The result is a unique legal arrangement: the government limits traditional tort remedies while simultaneously defining compensation through an administrative rating system. This framework places enormous importance on how disability benefits are structured, as they represent the primary avenue of redress available to injured service members.

The Structural Problem: A Workers’ Compensation Model for War Injuries

The deeper issue revealed by the controversy is structural. The VA disability system is fundamentally built on a workers’ compensation model. It measures disability primarily in terms of functional impairment and reduced earning capacity rather than permanent injury, loss of bodily integrity, or lifelong personal impact.

This model treats service-connected disability as an economic condition rather than a moral or national obligation. Compensation is calculated using standardized schedules designed to approximate average impairment of earning capacity. The system prioritizes administrative efficiency, cost predictability, and uniformity of outcomes.

Yet military service differs profoundly from civilian employment. Service members surrender personal autonomy, accept unlimited risk, and operate under orders that may place them in extreme danger. When injury occurs, they cannot pursue traditional civil litigation against the government due to long-standing legal doctrines that bar such claims. Unlike civilians injured in accidents, they cannot seek jury awards for pain, suffering, or loss of life enjoyment. Their sole remedy is the administrative benefits system.

This creates a fundamental tension. The government limits legal recourse while simultaneously defining compensation narrowly through a functional impairment framework. Many veterans view this structure as insufficient to account for the true cost of service — the loss of youth, permanent physical damage, psychological trauma, and irreversible changes to the course of a life.

The medication rule controversy exposed this tension by highlighting the gap between how the system measures disability and how veterans experience it.

The National Compact: A Different Understanding of Obligation

Underlying the public reaction is a broader moral argument about the nation’s compact with those who serve. Military service is not merely employment; it is a commitment to place one’s life, body, and future at the disposal of the state. In return, many believe the nation assumes a special duty of care that extends beyond economic calculations.

This perspective views compensation not simply as replacement of lost wages or functional capacity but as recognition of permanent sacrifice. The loss of a limb, the burden of lifelong treatment, or the enduring effects of combat trauma cannot be fully captured by a schedule of percentages. Even when technology restores mobility through prosthetics or medication controls symptoms, the individual has not been returned to the person he or she was before service.

A just system, under this view, should err in favor of the service member. It should operate with a presumption of generosity rather than suspicion and should treat benefits not as liabilities to be controlled but as obligations to be fulfilled.

At the same time, the nation must balance fiscal realities and administrative practicality. The challenge is not simply to expand benefits indefinitely but to design a system that reflects the unique nature of military sacrifice while maintaining fairness, sustainability, and public trust.

Toward a Just and Sustainable Veterans Compact: A Policy Framework

If the current controversy reveals anything, it is that the United States must more clearly define the nature of its obligation to those who serve. The challenge is not simply to increase or decrease benefits, but to establish a compensation philosophy that reflects both the realities of military service and the practical constraints of public policy.

A balanced approach would preserve administrative efficiency while more fully recognizing the unique character of military sacrifice.

First, policymakers should explicitly recognize that military disability differs fundamentally from civilian workplace injury. Service members accept risks imposed by the state and surrender legal remedies available to civilians. Compensation policy should therefore reflect this unique status by incorporating a presumption in favor of the service member when evaluating permanent injury and long-term impact.

Second, disability evaluation should distinguish between symptom management and restoration of health. Medical treatment that controls symptoms does not necessarily eliminate the underlying injury or its lifelong consequences. A fair system would recognize the continuing burden of treatment dependence and permanent bodily loss even when functional capacity improves.

Third, Congress and the Department of Veterans Affairs should consider supplementing the functional impairment model with additional recognition of permanent service-related loss. This could include enhanced compensation categories for irreversible injury, expanded quality-of-life considerations, or alternative compensation mechanisms that acknowledge lifelong personal impact.

Fourth, transparency and trust must become central principles of benefits administration. Policies perceived as limiting compensation through technical reinterpretation undermine confidence in the system and erode the moral legitimacy of the veterans’ compact. The government’s obligation should be communicated clearly as a commitment to fulfill, rather than minimize, its responsibilities.

Finally, the nation must confront the philosophical question underlying the entire system: what does it mean to compensate those who accept unlimited risk on behalf of the state? A just framework does not require unlimited liability, but it does require that the burden of uncertainty fall primarily on the nation rather than the individual who served.

A sustainable veterans policy must therefore balance fiscal responsibility with moral obligation, administrative order with individual justice, and functional assessment with recognition of permanent sacrifice. Only by addressing these tensions directly can the United States preserve the trust that underlies voluntary military service and honor the compact between the nation and those who defend it.