Opinion
VA disability rating rule brings clinical, ethical concerns
Deborah J. Mazzarella
February 24, 2026
Veterans Affairs Secretary Doug Collins announced Feb. 19, 2026, that he would not enforce a rule mandating that disability ratings be based on improvements with medication, rather than on the severity of the condition or injury. The rule, which had gone into effect two days earlier, led to an outcry from major veterans groups. A public comment period for the rule will continue through April 20. (Eric Kayne/Stars and Stripes)
ABOUT THE AUTHOR: Deborah J. Mazzarella, PsyD, ABCP, is a licensed clinical psychologist with over 30 years of experience, including work with active duty military and within the Department of Veterans Affairs health care system, who has conducted hundreds of compensation and pension evaluations for veterans.
I have served as a licensed clinical psychologist for over 30 years, worked with active duty military, within the Department of Veterans Affairs health care system, and have conducted hundreds of Compensation and Pension evaluations for veterans. Veterans often approach the C&P evaluation system with caution, having observed or heard about challenges in navigating the process. Whether intended or not, these perceptions and mistrust influence behavior and engagement even before an evaluation begins.
The VA recently issued an interim final rule amending 38 C.F.R. § 4.10, directing that disability ratings reflect how a veteran functions while using treatment or medication. Although the secretary has announced a pause in enforcement, many evaluators are currently applying the directive. The clinical and behavioral effects described below remain in practice and warrant careful consideration.
For veterans, the rule can inadvertently signal that improvement through treatment, therapy, or assistive devices could result in reduced benefits. This creates a situation in which veterans may delay treatment or adjustment to treatment, resist therapy completion, or limit the use of prosthetics and other supportive devices, not to manipulate the system, but to protect benefits essential for their daily lives. These behaviors are not malingering. They are predictable responses to a policy perceived as conditional on maintaining impairment rather than promoting recovery.
The implications are both clinical and systemic: uncertainty and distrust can lead to increased claims, reconsiderations and appeals, and compromise ongoing care. Maintaining stability through treatment engagement is more effective, clinically and economically, than repeatedly attempting to restore functioning.
A disability evaluation system should support transparent reporting and therapeutic engagement, while protecting benefits that veterans depend on. Until this rule is formally clarified or rescinded, uncertainty will continue to influence behavior and complicate care. Veterans deserve a system that supports recovery, protects stability, and ensures that treatment engagement does not put their benefits at risk.