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What is the VA Bilateral Factor?

The VA Bilateral Factor is a rule designed to provide additional compensation for veterans who have service-connected disabilities in both arms, both legs, or on both sides of the body. The VA recognizes that having a disability on both sides creates a greater overall impairment than having the same two disabilities on one side. When applicable, this rule adds an extra 10% to the combined rating for those specific limbs, reflecting the cumulative functional impact of bilateral conditions.

Which Disabilities Qualify for a Bilateral Rating?

The bilateral factor applies to the upper extremities (arms) and lower extremities (legs). This includes any condition from the shoulders down to the hands, and the hips down to the feet. Some common examples include:

• Tenosynovitis in both wrists
• Arthritis in both knees
• Radiculopathy (nerve pain) in both legs
• Limited range of motion in both shoulders

For more examples related to physical conditions, our guide on musculoskeletal conditions can be very helpful.

How the Bilateral Factor is Calculated into Your Combined Rating

The calculation is a specific step within the standard “VA Math” process:

1. First, combine the ratings for your two bilateral conditions only. For example, 20% for the right knee and 20% for the left knee.
2. Using VA Math, a 20% and 20% rating combine to 36%.
3. Next, calculate 10% of that combined value. 10% of 36 is 3.6.
4. Add that 10% value back to the combined value. 36 + 3.6 = 39.6. This is the “bilateral” rating.
5. Finally, you treat this 39.6% as a single disability rating when combining it with any other conditions you may have.

A Step-by-Step Example of the Bilateral Factor in Action

Let’s say a veteran has the following ratings:

• Right Knee: 20%
• Left Knee: 20%
• Back Condition: 40%

Step 1 (Calculate Bilateral): As shown above, the 20% right knee and 20% left knee combine to 36%. Adding the 10% bilateral factor (3.6) gives us 39.6%.

Step 2 (Combine with Other Ratings): Now, we combine the 40% back condition with the 39.6% bilateral rating.

• Start with the highest rating: 40%. This leaves 60% “healthy.”
• Take 39.6% of the remaining 60%, which is 23.76.
• Add that to the 40%: 40 + 23.76 = 63.76.

Step 3 (Round): 63.76 is rounded to the nearest 10, which is 60%. While the bilateral factor is intended to reflect total impairment, its impact on the final rounded rating depends on the veteran’s specific combination of clinical diagnoses. You can see this in action on our 2025 VA Disability Calculator, which includes this rule automatically.

Importance of Medical Documentation for Bilateral Conditions

A common oversight is not obtaining medical documentation for symptoms appearing on a second limb. If you have a service-connected knee problem, and your other knee starts to show symptoms due to overcompensation, it is important to seek a medical evaluation for the second knee. Clinical documentation of symptoms and functional limitations is necessary to provide medical evidence for the VA’s evaluation of secondary conditions, which the VA then uses to determine the application of the bilateral factor.

FAQ: VA Bilateral Factor

Do both disabilities have to be for the same condition?

No. For example, you could have arthritis in your right knee (20%) and radiculopathy in your left leg (10%), and the bilateral factor would still apply to those two ratings.

Does tinnitus in both ears count?

No. Tinnitus is a unique condition in that the VA only provides a single rating of 10%, regardless of whether it is in one ear or both. Therefore, the bilateral factor does not apply.

Can the bilateral factor apply to secondary conditions?

Absolutely. If you have a service-connected right knee injury and later develop a secondary condition in your left knee due to favoring the injured one, the bilateral factor would apply once the secondary condition is service-connected and medically documented.