23-1798
Vet. App.Mar 12, 2025Background
- Carlton Ingram, a veteran, appealed a Board of Veterans’ Appeals decision denying ratings above 20% for a back disability and 10% for a left ankle disability.
- Throughout VA examinations and appeals, Ingram consistently used medication to manage symptoms, including opioids and NSAIDs.
- The applicable Diagnostic Codes (DC 5237 for back and DC 5271 for ankle) do not mention medications in their criteria.
- The Board relied, in part, on clinical findings observed while Ingram was on medication.
- The Secretary conceded error on one issue (the failure to address certain evidence), but the Court’s key inquiry was whether the Board must discount the beneficial effects of medication when rating these disabilities under Jones v. Shinseki.
- The Court held oral argument to clarify the Jones precedent within the unique context of musculoskeletal rating regulations.
Issues
| Issue | Ingram's Argument | Secretary's Argument | Held |
|---|---|---|---|
| Must the Board discount beneficial effects of medication when rating disabilities? | Board erred by not discounting medication effects under Jones; DCs don't mention meds | Jones should not apply to musculoskeletal cases; regs already account for worst-case (unmedicated) scenarios | Jones applies; Board must discount med effects if DC does not reference medication |
| Does failure to review favorable range of motion evidence require remand? | Board ignored favorable VA records showing worse limitation | Conceded error and agreed remand was needed | Remand required to address all favorable evidence |
| Do special musculoskeletal regs (e.g., § 4.40) make Jones redundant? | Jones still necessary; regs do not guarantee discounting of med effects | Musculoskeletal regs already consider worst-case (thus, Jones is not needed) | Jones complements, not supplants, musculoskeletal eval regs; Board still must discount |
| Does Jackson v. McDonough change Jones/McCarroll rule? | No, Jackson reaffirms Jones/McCarroll | Jackson limits Board to what's in DC; Jones shouldn't apply if DC silent on meds | Jackson does not abrogate Jones/McCarroll; precedent remains |
Key Cases Cited
- Jones v. Shinseki, 26 Vet.App. 56 (2012) (Board must discount beneficial effects of medication if not listed in rating criteria)
- McCarroll v. McDonald, 28 Vet.App. 267 (2016) (Board can consider med effects only if rating criteria contemplate them)
- Jackson v. McDonough, 37 Vet.App. 87 (2023) (reaffirmed Jones; Board may not consider med effects if criteria are silent)
- Sharp v. Shulkin, 29 Vet.App. 26 (2017) (VA must consider functional loss during flare-ups for joint conditions)
- Mitchell v. Shinseki, 25 Vet.App. 32 (2011) (clarified the need for adequate joint motion examinations)
- DeLuca v. Brown, 8 Vet.App. 202 (1995) (disability eval must consider additional functional loss during flares)