Ingram v. Collins — Jones applies to musculoskeletal ratings that do not contemplate medication

Veteran Carlton Ingram appealed a Board decision denying a rating above 20% for a back disability and above 10% for a left ankle disability. The case centered on whether the Board was required, under Jones v. Shinseki, to discount the beneficial effects of medication when evaluating musculoskeletal disabilities under diagnostic codes that do not reference medication. The Secretary argued that Jackson, and the musculoskeletal regulations governing functional loss and flare-ups, displaced or made Jones unnecessary in this context.

The Court rejected that position. It reaffirmed that Jones and McCarroll remain good law and held that Jones applies when the relevant diagnostic code does not contemplate medication, including musculoskeletal ratings under DCs 5237 and 5271. The Court reasoned that flare-up and functional-loss regulations do not already account for medication effects, and that the Board must consider whether medication improved range of motion or reduced flare frequency and by how much. The Board also erred by failing to address favorable VA treatment records showing flexion of 30 degrees or less. The Court therefore set aside the denied rating portions and remanded for readjudication.

For musculoskeletal disabilities rated under diagnostic codes that do not mention medication, the Board must evaluate severity without the beneficial effects of medication and must address whether medication changed range of motion, flare frequency, or functional limitation.

Jones remains a live rating principle in musculoskeletal cases. If medication is helping the veteran, the Board must explain how it accounted for that benefit when the diagnostic code is silent on medication.

The decision prevents VA from inflating functional capacity simply because symptoms are controlled by medication when the rating criteria do not account for that factor. It is especially useful in joint and spine cases where medication, flare-ups, and range-of-motion estimates interact.

Ignoring the ameliorative effects of medication while rating under a diagnostic code that does not contemplate medication.

A veteran with lumbar spine limitation of motion takes opioid and anti-inflammatory medication that improves bending on exam. The Board rates based only on the medicated exam findings and ignores whether the unmedicated baseline would meet a higher rating. Under Ingram, that is error.

Use this case to argue for remand when the Board rates a spine, ankle, or other musculoskeletal disability without discussing the veteran’s medication use and the likely baseline severity absent treatment. It also supports challenging Board decisions that overlook favorable treatment records documenting worse range of motion.

Jones v. Shinseki, McCarroll v. McDonald, Jackson v. McDonough, Chavis v. McDonough, Sharp v. Shulkin, Mitchell v. Shinseki, DeLuca v. Brown, Tucker v. West