What Is Bilateral Factor
The bilateral factor is a 10% adjustment added to your combined disability rating when you have service-connected disabilities affecting both sides of your body, specifically both arms, both legs, or paired skeletal muscles like both shoulders or both knees. The VA applies this adjustment after calculating your combined rating but before finalizing your rating percentage.
When the VA Applies Bilateral Factor
The bilateral factor kicks in only when you meet specific conditions. You must have disabilities rated at least 10% each affecting the same paired body parts. For example, if you're rated 20% for right knee osteoarthritis and 20% for left knee osteoarthritis, the bilateral factor applies. If you have a 20% right shoulder rating but no left shoulder rating, the bilateral factor does not apply.
The bilateral factor applies to:
- Both upper extremities (arms, hands, fingers, or shoulder joints)
- Both lower extremities (legs, feet, or knee joints)
- Paired skeletal muscles affecting both sides of the spine or torso
It does not apply to unpaired conditions like tinnitus, PTSD, or conditions affecting only one side of your body, regardless of their severity.
How the Calculation Works
The VA uses a specific formula to apply the bilateral factor. First, they calculate your combined rating using the VA rating schedule and combining table. Then they apply the 10% bilateral adjustment to that combined rating. For example, if your combined rating before the bilateral factor is 50%, adding the 10% bilateral factor results in 55% (50% plus 10% of 50%, which equals 5 percentage points). This differs from simply adding 10 percentage points.
Impact on VA Compensation
The bilateral factor directly affects your monthly disability compensation. As of 2024, each percentage point difference in your rating can mean $50 to $100 per month in additional benefits, depending on your rating tier. A 10% bilateral adjustment at 50% combined rating increases your rating to 55%, which moves you into a higher compensation bracket.
Nexus Letters and C&P Exams
When filing or appealing a bilateral claim, your Compensation and Pension (C&P) examiner must document both conditions separately and clearly state whether they meet the bilateral factor criteria. During your C&P exam, ensure the examiner rates each paired body part individually. If the examiner only rates one side or treats the conditions as a single condition, request clarification. Your VSO (Veterans Service Officer) should review the C&P examination findings before you submit your formal claim or appeal.
A nexus letter from your private medical provider can strengthen a bilateral claim by establishing that both conditions are service-connected and documented in your medical records.
Bilateral Factor in Appeals
If the VA initially denied bilateral factor on your claim, you can appeal. Many bilateral factor denials occur because the VA failed to recognize that both conditions meet the 10% minimum threshold. Your VA-accredited representative or VSO can file a Notice of Disagreement highlighting the separate ratings for each paired body part and request that the bilateral factor be applied. The appeals process typically takes 4 to 6 months at the regional office level.
Common Questions
- Does bilateral factor apply if one condition is rated higher than the other? Yes. If your left knee is rated 20% and your right knee is rated 30%, both conditions meet the 10% threshold and bilateral factor applies.
- Can I claim bilateral factor for conditions rated below 10% each? No. The VA explicitly requires each condition to be rated at least 10% for bilateral factor to apply, even if combined they exceed 10%.
- How do I ensure the VA considers bilateral factor on my initial claim? State clearly in your claim narrative that you have service-connected disabilities affecting both sides of your body. Provide medical evidence documenting both conditions separately. Request that the C&P examiner rate each side individually and confirm bilateral factor eligibility in the exam report.
Related Concepts
Combined Rating is the foundation calculation to which bilateral factor is added. Disability Rating is the individual percentage assigned to each condition that determines whether bilateral factor eligibility is met.