Quick Answer: The bilateral factor is a 10% bonus the VA adds to your combined bilateral disabilities before mixing them with your other conditions. It applies when you have service-connected disabilities in both arms, both legs, or corresponding paired extremities. It’s required by law — the VA must apply it whether or not you ask for it.
What Is the Bilateral Factor?
The bilateral factor is codified in 38 CFR § 4.26. It recognizes that having disabilities in both paired extremities creates greater impairment than the combined ratings formula alone captures. When both limbs are affected, the additional strain on posture, gait, and overall function justifies a rating adjustment.
Step-by-Step: How the Bilateral Factor Is Applied
Here’s how the bilateral factor calculation works with two knee conditions:
- Left knee: 20% + Right knee: 10% → Combined bilateral: 28% (using the Whole Person method: 20% + 8% = 28%)
- Apply bilateral factor: 10% of 28% = 2.8%
- Bilateral combined value: 28% + 2.8% = 30.8% (call it 31%)
- This 31% now enters the combined ratings table with all other conditions as a single value
Without the bilateral factor, the knee conditions would enter at 28%. With it, they enter at ~31%. That 3% difference can push veterans over a rounding threshold — from 67% (rounds to 70%) to 70% (rounds to 70%), or more importantly, from 74% to 77% (both round to 70% vs 80%).
Which Conditions Qualify for the Bilateral Factor?
- Both knees (any combination of knee conditions)
- Both ankles
- Both hips
- Both shoulders
- Both elbows
- Both wrists
- Both hands
- Both feet
- Combinations across arm and leg pairs (e.g., right arm + right leg)
The Bilateral Factor Is Required — Not Optional
The VA must apply the bilateral factor when it is applicable — you do not need to request it. However, rating errors do occur. If you have bilateral conditions and suspect the bilateral factor was not applied to your rating, review your rating decision carefully and file a supplemental claim or request a Higher-Level Review if needed. A free accredited VSO can audit your math.
Frequently Asked Questions
Does the bilateral factor apply to tinnitus?
No. Tinnitus is rated as a single bilateral condition under Diagnostic Code 6260 regardless of which ears are affected. It already accounts for bilateral presentation in its single 10% rating. The bilateral factor applies to extremity conditions, not sensory bilateral conditions like tinnitus or hearing loss.
Does radiculopathy qualify for the bilateral factor?
Yes, if you have radiculopathy (nerve pain) in corresponding paired extremities — bilateral lower extremity radiculopathy or bilateral upper extremity radiculopathy — the bilateral factor applies to those conditions before they enter the combined ratings table.