VA Bilateral Factor Explained: How It Increases Your Disability Rating

Bottom Line Up Front

The bilateral factor is a special VA rating adjustment that increases disability ratings when conditions affect both sides of the body (both legs, both arms, both ears, both eyes, etc.). Veterans with bilateral conditions typically receive a 10% rating increase above their standard rating. For example, a 20% knee condition affecting both knees receives an additional 10%, resulting in 30% total. Bilateral factor applies to many conditions; understanding how it works can significantly increase your disability compensation. Processing time for bilateral adjustments: 2-4 weeks if properly documented.

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What Is Bilateral Factor and Why Does VA Apply It?

Bilateral factor is a VA adjustment recognizing that conditions affecting both sides of the body cause greater functional impairment than single-sided conditions.

Rationale

• Symmetrical impairment is more disabling: Bilateral knee problems prevent movement more than single knee problem
• Work capacity reduction: Bilateral hearing loss more limiting than unilateral
• Daily functioning: Bilateral arthritis affects more activities than unilateral
• Coordination and balance: Bilateral conditions affect these more than unilateral

Mathematical Application

If bilateral factor applies:

• Standard rating + 10% = new rating (with adjustment through VA formula)
• Example: 20% rating with bilateral factor becomes 30%
• Example: 30% rating becomes 40%
• Example: 50% rating becomes 60%

Important: Bilateral factor doesn't simply add 10% to your rating. VA uses a specific calculation, but in practice often results in approximately 10% increase.

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Which Conditions Qualify for Bilateral Factor

Conditions That Typically Qualify

Extremity Conditions (Most Common):

• Arthritis (knees, hips, ankles, shoulders, elbows, wrists)
• Paralysis or partial paralysis
• Amputation (both limbs)
• Nerve damage/neuropathy
• Weakness or atrophy
• Contracture

Sensory System Conditions:

• Hearing loss (both ears)
• Tinnitus (both ears)
• Vision impairment (both eyes)
• Loss of vision or partial vision

Other Conditions:

• Skin conditions affecting multiple body areas
• Some spinal cord conditions with bilateral effects
• Conditions explicitly mentioning bilateral in rating schedule

Conditions That Do NOT Qualify

Typically Excluded:

• PTSD (single organ system, not inherently bilateral)
• Mental health conditions
• Conditions naturally unilateral (single eye impairment, single ear hearing loss)
• Some spinal cord conditions rated for whole-person effect
• Conditions explicitly rated without bilateral factor option

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How to Determine If Your Condition Qualifies

Step 1: Identify Your Service-Connected Condition

Review your VA rating decision:

• Primary service-connected condition(s)
• Rating percentage assigned
• Condition codes listed

Step 2: Check Rating Schedule for Bilateral Factor

Access 38 CFR Part 4 (Schedule for Rating Disabilities):

• Search your condition
• Look for "bilateral factor" notation
• Rating schedule will note "For bilateral conditions" or similar language

Common Examples:

• Hearing loss: explicitly states bilateral adjustments
• Arthritis: rating schedule specifies bilateral factor applies
• Knee disabilities: bilateral factor applies per rating schedule
• Ankle disabilities: bilateral factor applies

Step 3: Verify Medical Evidence

Ensure medical records document:

• Condition affecting BOTH sides (both knees, both ears, both hands, etc.)
• Functional impairment on BOTH sides
• Not just suspicion of bilateral involvement

Step 4: File Bilateral Factor Claim

If condition qualifies and medical evidence supports bilateral involvement, file for bilateral factor rating adjustment.

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Examples of Bilateral Factor Application

Example 1: Bilateral Knee Arthritis

Starting Situation:

• Right knee degenerative joint disease: 20% rating
• Medical evidence also documents left knee arthritis (confirmed by X-ray)
• But VA rated only right knee

Filing for Bilateral Factor:

• Submit medical records showing left knee arthritis documented
• Request bilateral factor adjustment
• Argument: "My arthritis affects both knees equally; bilateral factor should apply"

Result:

• Original 20% right knee becomes 30% with bilateral adjustment
• Monthly increase: ~$198 additional compensation
• Retroactive payment: Depends on when bilateral condition documented

Example 2: Bilateral Hearing Loss

Starting Situation:

• Tinnitus and hearing loss: 30% rating (single ear notation)
• Audiologist reports symmetrical hearing loss affecting both ears

Filing for Bilateral Factor:

• Submit audiology reports showing bilateral symmetrical loss
• Request bilateral hearing loss rating adjustment
• Evidence: "Hearing loss affects both ears equally"

Result:

• Original 30% becomes 40% (or higher depending on VA calculation)
• Monthly increase: varies by rating
• Retroactive to date bilateral condition should have been recognized

Example 3: Bilateral Carpal Tunnel Syndrome

Starting Situation:

• Right wrist carpal tunnel: 20% rating
• Medical records also document left wrist symptoms, but not separately rated

Filing for Bilateral Factor:

• Submit medical records showing both wrists affected
• EMG/NCS studies showing bilateral involvement (if available)
• Request bilateral factor adjustment

Result:

• Original 20% becomes 30% with bilateral adjustment
• Monthly increase: ~$198

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Step-by-Step Process to Obtain Bilateral Factor Adjustment

Step 1: Review Your Current Rating Decision (Week 1)

Carefully read your VA rating letter:

• Which conditions rated and at what percentage?
• Does rating decision mention "bilateral"?
• Does it show single-sided rating for condition affecting both sides?
• Check rating schedule to verify bilateral factor applies to your condition

Red Flags for Bilateral Factor Opportunities:

• Rating decision says "left knee 20%" but you have right knee arthritis too
• Rating decision says "right ear hearing loss" but you have bilateral hearing loss
• Rating shows single extremity rated but medical records document bilateral involvement

Step 2: Gather Medical Evidence (Weeks 1-3)

Collect Documentation Showing Bilateral Condition:

• Medical records explicitly documenting both sides affected
• Imaging studies (X-rays, MRI) of both sides
• Examination notes from both sides
• Objective tests (if applicable) showing bilateral involvement
• Specialist evaluations documenting bilateral pathology

Key Evidence to Include:

• Radiologist reports: "Bilateral knee osteoarthritis"
• Audiologist reports: "Symmetrical bilateral sensorineural hearing loss"
• Exam findings: "Both wrists show signs of carpal tunnel"
• Functional documentation: "Cannot use either hand effectively," "Walks with difficulty on both legs"

Step 3: Prepare Supplemental Claim (Week 4)

Use Form 21-0960 (Supplemental Claim):

• List your service-connected condition
• Specify: "Requesting bilateral factor adjustment for [condition]"
• Explain: "My [condition] affects both sides, but was rated for only one side. Medical evidence documents bilateral involvement. VA rating schedule allows bilateral factor adjustment for this condition"

Narrative: "I am requesting bilateral factor rating adjustment for my [condition]. My original rating decision approved [X]% for my right [body part] condition. However, my medical records clearly document that the condition also affects my left [body part] equally. The VA rating schedule for [condition code] explicitly provides for bilateral factor adjustment. Since both sides are affected, I qualify for this adjustment. Attached medical evidence documents bilateral [condition] pathology and functional impairment on both sides."

Step 4: Compile Documentation (Week 4)

Complete Supplemental Claim Package:

1. Form 21-0960 (Supplemental Claim)
2. Original rating decision showing current rating
3. VA rating schedule for your condition (print from 38 CFR Part 4)
4. All medical evidence documenting bilateral condition
5. Imaging/test results showing both sides affected
6. Specialist evaluations confirming bilateral pathology
7. Personal statement explaining bilateral functional impairment

Step 5: File Supplemental Claim (Week 5)

Filing Options:

• Online at VA.gov (fastest)
• Mail to your VA Regional Office
• In-person at local VA Medical Center

After Filing:

• Monitor claim status at VA.gov
• VA may request additional information
• C&P exam unlikely unless medical evidence insufficient
• Decision typically within 30-60 days for straightforward bilateral adjustments

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Timeline Expectations

Processing Timeline for Bilateral Factor Claims

Standard Timeline: 30-60 days

Timeline	Action
Days 1-7	Gather bilateral condition medical evidence
Days 7-14	Prepare supplemental claim
Days 14-15	File supplemental claim
Days 15-20	VA receives and logs claim
Days 20-40	VA reviews evidence
Days 40-60	Decision issued

Factors Affecting Timeline:

• Strength of medical evidence (strong evidence processes faster)
• Whether VA already has bilateral documentation in file
• VA workload
• If C&P exam needed (adds 4-8 weeks)

Retroactive Payment

If bilateral factor approved:

• Retroactive date usually: when condition first documented as bilateral in medical records
• Calculate back pay: (new percentage - old percentage) × number of months × monthly rate
• Example: 20% to 30% increase ($200/month) for 24 months = $2,400 retroactive

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Real Examples

Success Example: Bilateral Hearing Loss (Increased from 30% to 40%)

Background: Combat veteran, service-connected hearing loss originally rated at 30% (right ear only noted in rating decision).

Situation: Medical records included audiologist evaluation showing symmetrical bilateral sensorineural hearing loss. Both ears equally affected, but VA rating decision only referenced right ear.

Filing Process:

• Gathered all audiometry reports showing bilateral loss
• Filed supplemental claim requesting bilateral factor adjustment
• Submitted rating schedule excerpt showing bilateral factor applies to hearing loss
• Personal statement explaining need for hearing aids in both ears

Result: Bilateral hearing loss rating approved at 40%. Monthly increase: $198. Retroactive payment: $2,376 (covering 12 months from when bilateral condition should have been recognized).

Success Factor: Clear audiology documentation of bilateral symmetrical loss; proper supplemental claim form; rating schedule reference

Learning Example: Bilateral Knee Arthritis (Initially Denied, Then Approved)

Initial Situation:

• Right knee osteoarthritis rated 20%
• Left knee imaging showed arthritis, but not separately rated
• Veteran filed requesting bilateral adjustment

Initial Denial Reason:

• VA examiner noted: "Left knee not causing significant functional impairment separately"
• Rating decision: "Right knee 20% represents bilateral functional impairment"
• Argument: bilateral adjustment only applies if both sides cause independent significant impairment

Appeal and Approval:

• Submitted more detailed functional evidence showing both knees impair walking/mobility
• Obtained orthopedic specialist letter: "Bilateral knee arthritis significantly limits function; each knee contributes to overall functional limitation"
• Resubmitted with evidence that both knees affected and VA rating schedule explicitly allows bilateral factor for arthritis

Second Outcome: Bilateral factor adjustment approved. Rating increased from 20% to 30%.

Key Lesson: VA sometimes denies bilateral factor claims arguing overall rating already reflects bilateral impact. Overcome this with: (1) specific rating schedule language allowing bilateral factor, (2) clear documentation that both sides affected, (3) functional evidence showing impairment from both sides, (4) emphasis that bilateral factor is mathematical adjustment, not additional condition.

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Common Mistakes to Avoid

1. Assuming All Conditions Qualify for Bilateral Factor

Mistake: Filing for bilateral factor on conditions that don't qualify (PTSD, mental health).

Fix: Check rating schedule first. Only conditions explicitly allowing bilateral factor qualify. Not all paired-side conditions automatically qualify.

2. Insufficient Bilateral Documentation

Mistake: Filing with only assumption that both sides affected, without medical documentation.

Fix: Provide clear medical evidence documenting both sides affected. Imaging, specialist reports, examination findings all critical.

3. Weak Personal Statement

Mistake: Not explaining how bilateral condition creates greater impairment than single-sided.

Fix: Detailed examples: "With both knees arthritic, I cannot walk more than [X] distance," "Both ears hearing loss prevents normal conversation on either side," "Both hands carpal tunnel prevents me from holding items."

4. Not Referencing Rating Schedule

Mistake: Filing without showing rating schedule specifically allows bilateral factor for condition.

Fix: Print relevant rating schedule section showing bilateral factor applies. VA responds to proper regulatory references.

5. Timing Issues

Mistake: Filing years after condition first documented as bilateral without explanation.

Fix: Can still file anytime. Explain in claim: "Although left [body part] condition documented in [date], bilateral factor not addressed in original rating. Now requesting proper adjustment."

6. Inadequate Current Exam Evidence

Mistake: Relying only on old medical records without current exam documenting bilateral condition.

Fix: Schedule current VA or private exam documenting bilateral condition. Current evidence stronger than historical.

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Resources and Support

Government Resources

• VA rating schedules: www.va.gov/disability/ (38 CFR Part 4)
• File supplemental claim: www.va.gov/disability/file-claim/
• VA helpline: 1-800-827-1000

Veteran Organizations

• VFW, American Legion, DAV: Can review your case for bilateral factor opportunities
• Free representation available through VSO

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FAQ

Q: Can I get bilateral factor for conditions that already have high ratings?

A: Yes. Bilateral factor applies to any qualifying condition regardless of current rating percentage. A 50% rating can become 60% with bilateral factor if condition qualifies.

Q: If bilateral factor is approved, do I go through C&P exam?

A: Usually not. If VA already has sufficient medical evidence documenting bilateral condition, no exam needed. C&P exam only if evidence insufficient.

Q: How long does bilateral factor adjustment take to process?

A: Typically 30-60 days for straightforward cases. Complex cases may take longer if additional medical evaluation needed.

Q: Can I file for bilateral factor on multiple conditions?

A: Yes. If multiple conditions qualify for bilateral factor (bilateral knees AND bilateral hearing loss, for example), file for both in single supplemental claim.

Q: What is the maximum rating increase from bilateral factor?

A: Varies by condition, but typically approximately 10% increase to rating. Some conditions have smaller adjustments.

Q: If my condition is rated as "bilateral" already, do I need to file again?

A: No. If your rating decision says "bilateral," bilateral factor already applied. No additional claim needed.

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Final Recommendation

Bilateral factor is an often-overlooked opportunity to increase VA disability ratings for veterans with paired-organ or paired-extremity conditions affecting both sides. If your medical records document bilateral involvement but your rating decision shows only single-sided rating, you likely qualify for bilateral factor adjustment.

Action Items:

1. Review your current rating decision carefully
2. Check 38 CFR Part 4 rating schedule for your condition
3. Gather medical evidence documenting bilateral involvement
4. File supplemental claim if bilateral factor applies
5. Contact VFW/American Legion/DAV if unsure about bilateral factor eligibility

Next Step: Review your current VA rating decision. If you have conditions affecting both sides, consult a Veterans Service Organization about bilateral factor opportunities. This is a relatively straightforward rating increase for many veterans.

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Sources: VA Claims Filing, Veterans Benefits Administration, 38 CFR Part 3