Claim Raven explanation
What this means
The bilateral factor can apply when compensable disabilities affect both arms, both legs, or paired skeletal muscles. VA combines the qualifying ratings and applies the adjustment before continuing the overall rating calculation.
It is not an automatic ten-point increase in the final rating. The section defines qualifying pairs and includes an exception when excluding one or more bilateral disabilities produces a higher combined evaluation.
How this helps your claim
This helps you check how left- and right-sided ratings were handled. The important facts are the affected extremities, compensable evaluations, and the complete combined-rating calculation.
What to check in your records
Use your decision, examination reports, and relevant records to check the following points.
- Identify all qualifying left- and right-sided disabilities and their percentages.
- Check whether each side has a compensable level of disability.
- Compare the calculation with the section's exception for a more favorable combined evaluation.
Identify the qualifying pair before calculating
The bilateral factor concerns specified compensable disabilities affecting paired extremities or skeletal muscles. List the side, body part and evaluation for each condition. A condition being bilateral in everyday language does not by itself establish every regulatory requirement.
The factor is applied within the combined-rating calculation, not added as ten percentage points to the final award. The current section also addresses circumstances where excluding certain bilateral disabilities yields a higher result. Read that exception rather than assuming a mechanical adjustment always benefits the overall calculation.
Does any condition affecting both sides receive the bilateral factor?
No. The rule defines the qualifying pairs and compensable involvement. It should not be applied to every paired organ or bilateral diagnosis. Confirm the body parts and evaluations involved, then use the actual combination method and exception in the regulation.
Official regulatory text
38 CFR § 4.26
eCFR snapshot: September 3, 2026. Layout and spacing are adapted for reading. The full section and its tables are included below.
§ 4.26 Bilateral factor.
Except as provided in paragraph (d) of this section, when a partial disability results from disease or injury of both arms, or of both legs, or of paired skeletal muscles, the ratings for the disabilities of the right and left sides will be combined as usual, and 10 percent of this value will be added (i.e., not combined) before proceeding with further combinations, or converting to degree of disability. The bilateral factor will be applied to such bilateral disabilities before other combinations are carried out and the rating for such disabilities including the bilateral factor in this section will be treated as one disability for the purpose of arranging in order of severity and for all further combinations. For example, with disabilities evaluated at 60 percent, 20 percent, 10 percent and 10 percent (with the two 10 percent evaluations being bilateral disabilities), the order of severity would be 60, 21 and 20. The 60 and 21 combine to 68 percent and the 68 and 20 combine to 74 percent, converted to 70 percent as the final degree of disability.
(a) Definitions. The use of the terms “arms” and “legs” is not intended to distinguish between the arm, forearm and hand, or the thigh, leg, and foot, but relates to the upper extremities and lower extremities as a whole. Thus with a compensable disability of the right thigh, for example, amputation, and one of the left foot, for example, pes planus, the bilateral factor applies, and similarly whenever there are compensable disabilities affecting use of paired extremities regardless of location or specified type of impairment.
(b) Procedure for four affected extremities. The correct procedure when applying the bilateral factor to disabilities affecting both upper extremities and both lower extremities is to combine the ratings of the disabilities affecting the 4 extremities in the order of their individual severity and apply the bilateral factor by adding, not combining, 10 percent of the combined value thus attained.
(c) Applicability. The bilateral factor is not applicable unless there is partial disability of compensable degree in each of 2 paired extremities, or paired skeletal muscles.
(d) Exception. In cases where the combined evaluation is lower than what could be achieved by not including one or more bilateral disabilities in the bilateral factor calculation, those bilateral disabilities will be removed from the bilateral factor calculation and combined separately, to achieve the combined evaluation most favorable to the veteran.
[29 FR 6718, May 22, 1964, as amended at 88 FR 22917, Apr. 14, 2023]
Related references
- 38 CFR § 4.1: What a VA disability rating measures
- 38 CFR § 3.159: VA duty to assist: records and examinations
Ready to review your own document? Start your free claim review.