Bilateral Factor at C&P Exams: How It Affects Your VA Disability Rating

If you have service-connected conditions affecting both arms, both legs, or paired extremities, you may be entitled to an additional 10% in your VA disability rating. This is known as the Bilateral Factor, and it can significantly increase your total combined rating and compensation.

The Bilateral Factor is applied when you have a disability affecting both sides of your body such as both knees, both shoulders, or both feet. At your C&P exam, the examiner will evaluate each extremity individually, and the rater will then apply the Bilateral Factor to your combined rating. Understanding how this works can help you ensure you receive the maximum compensation you deserve.

What Is the Bilateral Factor?

The Legal Basis

The Bilateral Factor is established under 38 CFR § 4.26. It states:

"When a veteran has a disability of both arms, both legs, or both paired extremities, the ratings for the disabilities of the paired extremities will be combined and then an additional 10% will be added to the combined rating."

How the Bilateral Factor Is Calculated

Example Calculation

Let's say you have the following ratings:

• Left knee: 20%
• Right knee: 20%
• Left shoulder: 10%
• Right shoulder: 10%
• PTSD: 50%

Step 1: Combine bilateral conditions

• Left knee 20% + Right knee 20% = 36% combined
• Add Left shoulder 10% + Right shoulder 10% = 19% combined
• Combine 36% and 19% = 48% combined

Step 2: Add Bilateral Factor

• 48% x 10% = 4.8% (rounds to 5%)
• 48% + 5% = 53%

Step 3: Combine with other conditions

• 53% (bilateral combined) + 50% PTSD = 77% (rounds to 80%)

Final Combined Rating: 80%

Without the Bilateral Factor, the rating would have been 50% + 20% + 20% + 10% + 10% = 76% (rounds to 80%). In this case, the Bilateral Factor does not change the final rating, but in many cases it can make a difference.

Which Conditions Qualify for the Bilateral Factor?

Conditions That May Qualify

How the Bilateral Factor Is Evaluated at a C&P Exam

1. The Examiner Evaluates Each Extremity

The examiner will evaluate each extremity individually. For example, if you have knee pain, the examiner will evaluate your left knee and right knee separately.

2. The Examiner Documents the Findings

The examiner will document the severity of each extremity on the DBQ. The findings will be used by the rater to assign a rating for each extremity.

3. The Rater Applies the Bilateral Factor

The rater will identify which conditions affect paired extremities, combine the ratings, and apply the Bilateral Factor.

4. The Rater Calculates the Final Rating

The rater will combine the bilateral rating (with the Bilateral Factor added) with all other ratings to calculate your final combined rating.

Common Mistakes Veterans Make

How to Maximize Your Bilateral Factor Rating

Realistic Veteran Scenario: Bilateral Factor Calculation

Case Study: Michael, a U.S. Army Veteran

Michael has service-connected conditions affecting both knees and both shoulders. His ratings are:

• Left knee: 10%
• Right knee: 10%
• Left shoulder: 20%
• Right shoulder: 20%
• Tinnitus: 10%

Step 1: Combine bilateral conditions

• Left knee 10% + Right knee 10% = 19% combined
• Left shoulder 20% + Right shoulder 20% = 36% combined
• Combine 19% and 36% = 48% combined

Step 2: Add Bilateral Factor

• 48% x 10% = 4.8% (rounds to 5%)
• 48% + 5% = 53%

Step 3: Combine with other conditions

• 53% + 10% tinnitus = 58% (rounds to 60%)

Final Combined Rating: 60%

Without the Bilateral Factor, Michael's rating would have been 20% + 20% + 10% + 10% + 10% = 54% (rounds to 50%). The Bilateral Factor added 10% to his rating.

Actionable Steps: Maximizing Your Bilateral Factor

1. Claim Each Extremity Separately: File separate claims for each affected extremity.
2. Document All Symptoms: Describe symptoms in both extremities.
3. Attend All C&P Exams: Don't miss exams for bilateral conditions.
4. Get a Nexus Letter: If needed, get a nexus letter linking each extremity to your service.
5. Review Your Rating Decision: Check if the Bilateral Factor was applied.
6. Appeal if Necessary: If the Bilateral Factor was not applied, file an appeal.

Frequently Asked Questions About the Bilateral Factor

What is the Bilateral Factor?

The Bilateral Factor is an additional 10% added to the combined rating for disabilities affecting both arms, both legs, or paired extremities.

How is the Bilateral Factor calculated?

The ratings for all bilateral conditions are combined, then an additional 10% is added to the combined rating.

What conditions qualify for the Bilateral Factor?

Conditions affecting paired extremities: arms, legs, shoulders, knees, hands, feet, wrists, ankles, elbows, and hips.

Do both extremities need to be service-connected?

Yes. Both extremities must have service-connected conditions to qualify for the Bilateral Factor.

Can the Bilateral Factor increase my rating?

Yes. The Bilateral Factor can increase your combined rating by up to 10%.

What if I have a condition affecting one arm and one leg?

The Bilateral Factor applies to paired extremities. Arms are paired, and legs are paired. A condition affecting one arm and one leg would not qualify for the Bilateral Factor.

How can I check if the Bilateral Factor was applied?

Review your rating decision. It should indicate whether the Bilateral Factor was applied. If you don't see it, you can file an appeal.

Disclaimer: This article is for informational purposes only and does not constitute legal, medical, or financial advice. It is not affiliated with the U.S. Department of Veterans Affairs. VA policies and regulations are subject to change. Please verify all current details on the official VA website (VA.gov) before filing a claim. For personalized assistance with your claim, we highly recommend consulting a Veterans Service Organization (VSO) such as the DAV, VFW, or American Legion, or an accredited claims agent or attorney.