VA Bilateral Factor Explained
🇺🇸 Bilateral Factor · 2026

VA Bilateral Factor Explained

The 10% bonus most veterans miss — when the bilateral factor applies, how to calculate it, and how to make sure the VA applied it correctly.

📅 Published May 9, 2026 ⏱ 7 min read ✍️ VA Claims US Editorial Team
10%Bilateral Bonus
38 CFR§ 4.26
PairedBody Parts
$300+Avg Monthly Impact

The bilateral factor is one of the most underused — and most misunderstood — VA benefits. If you have service-connected disabilities affecting both sides of paired body parts (both knees, both shoulders, both arms), you're entitled to an additional 10% bonus on the combined rating of those bilateral disabilities. This bonus can move you from one rating tier to the next, adding hundreds of dollars per month.

This guide explains exactly when the bilateral factor applies, how it's calculated, and how to make sure your VA decision-maker applied it correctly.

💡The 10% Bonus Most Veterans MissUnder 38 CFR § 4.26, when ratings affect paired body parts, the VA adds a 10% bonus to the combined bilateral total. This single calculation can move a 50% combined rating to 60%+, adding $300+ per month for life.

01
What the Bilateral Factor Is

The bilateral factor is an additional 10% added to the combined rating of disabilities affecting both sides of paired body parts. It's based on the recognition that when both sides of a paired structure are disabled, the functional impact is greater than the sum of either side alone.

Example: a single bad knee is a problem. Two bad knees is more than twice as bad — because you have no good leg to compensate. The VA acknowledges this with the bilateral factor.

02
When the Bilateral Factor Applies

The bilateral factor applies to disabilities affecting paired body parts:

🦵
Lower Extremities
Both knees, both ankles, both hips, both feet, both legs.
💪
Upper Extremities
Both arms, both shoulders, both elbows, both wrists, both hands.
👁️
Other Pairs
Both eyes (under specific conditions), both ears (under specific conditions).

The factor does NOT apply to:

  • Conditions affecting only one side
  • Conditions affecting the spine, head, or central body (these aren't paired)
  • Internal organ pairs (kidneys, lungs) — these have separate rating rules
  • Conditions where both sides are caused by a single non-bilateral condition

03
How the Bilateral Factor Is Calculated

The calculation has three steps:

1

Combine Your Bilateral Ratings First

Use standard VA math to combine ALL bilateral disability ratings into a single combined bilateral total — before considering any non-bilateral conditions.

2

Add 10% of That Total

Multiply the combined bilateral total by 0.10. Add the result back to the combined bilateral total.

3

Then Combine With Other Conditions

Use the bilateral-adjusted total when combining with your remaining (non-bilateral) condition ratings.

04
Worked Examples

🧮 Example A: Two Bilateral Knee Conditions

1
Left knee 20% + right knee 10%. Combine: 20% + (80% × 10%) = 28%
28% bilateral
2
Add 10% bilateral factor: 28% + (28% × 10%) = 28% + 2.8% = 30.8%
30.8%
3
Round to nearest 10% → 30%
Final: 30%
30%
vs 30% without bilateral factor (in this case the rounding absorbs the bonus)

🧮 Example B: Bilateral Knees + PTSD

1
Bilateral combined (left 20% + right 20% = 36%) + 10% bilateral factor = 36% + 3.6% = 39.6%
39.6%
2
Combine with PTSD 50%: 50% + (50% × 39.6%) = 50% + 19.8% = 69.8%
69.8%
3
Round → 70%
Final: 70%
70%
vs 60% without bilateral factor — that's $373/month difference
⚠️The Rounding Can Eat the BonusThe bilateral factor matters most when your raw combined rating sits near a 10% boundary. A combined of 67.5% rounds to 70% with the bilateral factor; without it, you may sit at 64% which rounds to 60%. The cents of bilateral bonus can equal hundreds of dollars per month.

05
Why the Bilateral Factor Often Gets Missed

VA raters work fast and the bilateral factor is easy to overlook, especially when:

  • The two bilateral conditions have different diagnostic codes (e.g., left knee instability + right knee meniscus tear)
  • The bilateral conditions were rated in separate decisions over time
  • One side is rated under a 'bilateral' code while the other is rated separately
  • The veteran has many conditions and the bilateral relationship isn't obvious in the file
  • The rating decision uses a calculator that doesn't auto-apply the factor
📋
Math
Read: How Combined Ratings Are Calculated
→

06
How to Make Sure the Bilateral Factor Is Applied

1

Identify Your Bilateral Conditions

List all your service-connected conditions. Mark any pair affecting the same body part on both sides.

2

Check Your Rating Decision

Look for the explanation of how your combined rating was calculated. The bilateral factor should be explicitly noted.

3

Calculate Both Ways

Use a combined rating calculator to compute your rating WITH and WITHOUT the bilateral factor. The difference shows what's at stake.

4

File a Higher-Level Review If Missed

If the VA didn't apply the factor where it should have, this is a clear regulatory error — exactly what HLR is designed to fix.

🇺🇸 Free VA Claims Assistance

Is Your Bilateral Factor Applied?

Many veterans miss out on hundreds of dollars per month because the bilateral factor wasn't applied. Get a free review of your rating math.

🚀 Schedule Free ConsultationNo obligations. 100% free consultation. About VA Claims US →

07
Frequently Asked Questions

10% of your combined bilateral rating. In practical terms, this often means a 5-10 percentage point bump in your final combined rating — worth $200-$500/month.
Yes. Any paired body part qualifies — knees, ankles, feet, hips, shoulders, elbows, wrists, hands, and certain eye/ear conditions.
Doesn't matter. The bilateral factor applies as long as both sides have service-connected ratings, regardless of which is higher.
It's supposed to be, but VA raters frequently miss it. Always verify it was applied by checking your rating decision math.
No. Both sides must be service-connected. If one side isn't yet, file for service connection first, then the bilateral factor will apply once both are connected.
VA Claims US Editorial Team
VA Claims US Editorial Team
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The VA Claims US editorial team is dedicated to helping veterans and their families understand and navigate the VA disability system. Our content is reviewed for accuracy against current VA regulations and updated whenever rates or policies change. Have a question? Contact us here.