Bilateral Factor: Worked Examples in Dollars

The bilateral factor adds 10% of your paired ratings' combined value — not 10 points to your rating — and it only changes your monthly pay when it moves your final rounded rating. The four worked examples below show each case in dollars, using the 2026 VA compensation table (effective December 1, 2025).

Last factually verified: November 1, 2026. Compensation figures: 2026 VA table, effective December 1, 2025. If you spot an error, contact us and verified corrections will be published with a note.

How the math works, in order

Two regulations do all the work. 38 CFR 4.25 is the combined-ratings table: ratings are arranged greatest first, and each new rating applies only to the efficiency remaining after the ones before it. The intermediate combined value is carried at whole-number precision, and the conversion to the nearest multiple of 10 happens once, at the very end — with values ending in 5 adjusted upward.

38 CFR 4.26 then adds the bilateral step, before any other combining:

1. Combine the qualifying paired ratings as usual under 4.25.
2. Add 10% of that combined value (added, not combined), and round to the nearest whole number. That subtotal counts as one disability from here on.
3. Arrange that subtotal with all other ratings in order of severity and combine greatest first.
4. Convert the final combined value to the nearest multiple of 10, once, with 5s upward.

The regulation's own example shows the sequence: ratings of 60%, 20%, 10% and 10%, with the two 10% ratings bilateral. The pair combines to 19, plus 10% gives 20.9, carried forward as 21. The order of severity becomes 60, 21, 20. Combining gives 68, then 74, which converts to a 70% final rating.

Which paired disabilities qualify

Under 4.26(c), the factor does not apply unless there is partial disability of compensable degree in each of two paired extremities, or paired skeletal muscles. In practice that means:

• Both arms (upper extremities), both legs (lower extremities), or paired skeletal muscles.
• Both sides must be compensably rated. A 0% rating on one side does not make a pair, and a single-sided rating combines under the plain combined-rating method instead.
• “Arms” and “legs” mean the extremities as a whole, not a specific joint. The regulation says so expressly in 4.26(a): a compensable disability of the right thigh and one of the left foot still qualifies, because what matters is paired extremities, regardless of location or type of impairment.

What the factor is not: it is not 10 percentage points added to your final rating, and it is not 10% of your final rating. It is 10% of the paired ratings' combined value only, applied before anything else is combined.

When it changes your rating, and when it changes your pay

Two different questions, and they have different answers:

• Your final rating changes only when the bilateral subtotal pushes the intermediate combined value across a rounding boundary — 45, 55, 65, 75, 85, or 95. Example 1 crosses one; Example 2 does not.
• Your monthly pay changes only when your final rounded rating changes, because VA prices compensation by the final rating. An intermediate change that leaves the final rating unchanged changes nothing in dollars.
• Your household changes the dollar size of a step. The same rating increase is worth a different number of dollars for a veteran alone than for a veteran with a spouse and children (Example 4). At 10% and 20%, dependents add nothing — VA pays the same rate with or without dependents at those ratings.

Example 1: The bilateral factor raises the final rating

The veteran (hypothetical): rated 30% for one knee and 20% for the other knee, and nothing else. Both knees are compensably rated, so the pair qualifies.

Without the bilateral factor (plain 4.25 combining, greatest first):

• Start with 30%. The remaining efficiency is 70%.
• Apply 20% to that remaining 70%: 20% of 70 = 14. Combined value: 30 + 14 = 44.
• Convert once to the nearest 10: 44 becomes 40%.

With the bilateral factor (4.26):

• Combine the pair as usual: 44, exactly as above.
• Add 10% of 44: 44 + 4.4 = 48.4, rounded to the nearest whole number: 48. That 48 now counts as one disability.
• It is the only disability, so the combined value is 48. Convert once to the nearest 10: 48 becomes 50%.

Result: 40% without the factor, 50% with it. The factor moved the intermediate value from 44 to 48, across the 45 rounding boundary — and that is the whole reason the final rating moved. Example 4 prices this exact step in dollars.

Example 2: The intermediate value moves, the final rating does not

The veteran (hypothetical): the same 30% and 20% knees as Example 1, plus an unrelated 50% rating.

Without the bilateral factor: arrange greatest first — 50, 30, 20.

• Start with 50%. Remaining efficiency: 50%.
• Apply 30% to the remaining 50%: 30% of 50 = 15. Combined value: 50 + 15 = 65.
• Apply 20% to the remaining 35%: 20% of 35 = 7. Combined value: 65 + 7 = 72.
• Convert once to the nearest 10: 72 becomes 70%.

With the bilateral factor: the pair still combines to 44, plus 10% gives the subtotal 48, which counts as one disability. Arrange with the other rating, greatest first — 50, 48.

• Start with 50%. Remaining efficiency: 50%.
• Apply 48% to the remaining 50%: 48% of 50 = 24. Combined value: 50 + 24 = 74.
• Convert once to the nearest 10: 74 becomes 70%.

Result: the intermediate value moved from 72 to 74, but no rounding boundary sits between them, so the final rating is 70% either way — and monthly pay is identical. This is the case most veterans misunderstand: a bigger intermediate number is not a bigger check unless it crosses a boundary.

Example 3: The 4.26(d) exception — when the factor would hurt

The veteran (hypothetical): rated 90% for one condition, 30% for another, and 10% for each knee. The two knees qualify as a pair.

With full bilateral treatment:

• The pair combines to 19 (10 + 10% of the remaining 90). Add 10%: 19 + 1.9 = 20.9, carried forward as 21.
• Arrange greatest first — 90, 30, 21. Start with 90%; remaining efficiency is 10%.
• Apply 30% to the remaining 10%: 30% of 10 = 3. Combined value: 93.
• Apply 21% to the remaining 7%: 21% of 7 = 1.47. Combined value: 93 + 1.47 = 94.47, rounded to 94.
• Convert once to the nearest 10: 94 becomes 90%.

Without any bilateral factor: arrange greatest first — 90, 30, 10, 10.

• Start with 90%. Apply 30% to the remaining 10%: 93.
• Apply 10% to the remaining 7%: 10% of 7 = 0.7. Combined value: 93 + 0.7 = 93.7, rounded to 94.
• Apply the second 10% to the remaining 6%: 10% of 6 = 0.6. Combined value: 94 + 0.6 = 94.6, rounded to 95.
• Convert once to the nearest 10, with 5s upward: 95 becomes 100%.

Result: full bilateral treatment gives 90%; leaving the factor out gives 100%. Under 38 CFR 4.26(d), when the combined evaluation is lower than what could be achieved by not including one or more bilateral disabilities in the bilateral factor calculation, those disabilities are removed from the bilateral calculation and combined separately, to achieve the combined evaluation most favorable to the veteran. So the answer here is 100%, with the knees combined as ordinary ratings.

Why it happens: the bilateral subtotal replaces two combining steps with one. Near the top of the scale, where each step adds only a fraction of a point, losing a step can cost more than the 10% adds — and here that single lost point sits exactly on the 95 rounding boundary, so it costs a full 10 points of final rating. The exception exists for exactly this shape of case. It is rare, because the factor usually helps or is neutral — but “usually” is why the regulation has a paragraph (d).

Example 4: The same rating step, in actual 2026 dollars

The veteran (hypothetical): the Example 1 veteran — 30% and 20% knees — whose final rating is 40% without the factor and 50% with it. Same knees, same household; only the factor changes. Dollar figures are from the 2026 VA compensation table, effective December 1, 2025.

How the spouse-and-children figures are built (VA's published method: the basic rate covers one child; each further child adds a fixed amount):

• At 40%: basic rate for spouse + 1 child, $947.84, plus $43.00 for the second child under 18 = $990.84 per month.
• At 50%: basic rate for spouse + 1 child, $1,322.90, plus $54.00 for the second child under 18 = $1,376.90 per month.
• Annual figures are monthly × 12: $990.84 × 12 = $11,890.08 at 40%; $1,376.90 × 12 = $16,522.80 at 50%; the difference is $4,632.72 per year.
• Veteran alone: $795.84 × 12 = $9,550.08 at 40%; $1,132.90 × 12 = $13,594.80 at 50%; the difference is $4,044.72 per year.

Result: the same bilateral-factor step is worth $337.06 a month to a veteran alone and $386.06 a month to a veteran with a spouse and two children under 18 — a $49.00-a-month difference driven entirely by dependent amounts, not by the factor itself. That is why any honest dollar example has to name its household: a rating step has no single dollar value.

Four extremities: one pooled subtotal, not two factors

When both upper and both lower extremities qualify, 4.26(b) gives a single procedure: combine the ratings of all four extremities in order of their individual severity, then add 10% of that one combined value. There is no second factor for the second pair. A veteran with qualifying ratings on both arms and both legs gets one bilateral subtotal covering all four, which then counts as one disability alongside any others.

What the bilateral factor cannot do

• It cannot create a pair out of a single-sided rating, a 0% rating, or two ratings that are not paired extremities or paired skeletal muscles.
• It cannot be applied twice to the same pair, or once per pair when four extremities are involved.
• It cannot change your pay on its own. Only a change in the final rounded rating changes the table row VA pays from.
• It cannot substitute for VA's decision that your conditions qualify as paired. If VA has not rated both sides as paired, the arithmetic in this article does not apply to your claim.
• It cannot be checked against a single “bilateral factor” line on an award letter, because VA's rating decision shows combined values, not a separate factor line. Check the combined evaluation, not a factor amount.

Try it with your own ratings

These examples are fixed arithmetic. To run your own combination, use the site's calculators — they apply the same 4.25/4.26 procedure, including the 4.26(d) check:

• Bilateral factor calculator — enter paired and unpaired ratings and see the subtotal, the comparison without the factor, and whether the 4.26(d) exception fires.
• Combined rating calculator — plain 4.25 combining without any bilateral treatment.
• VA disability pay calculator — price any final rating at the 2026 table for your household.

Sources

• 38 CFR 4.26, Bilateral factor — the factor, the four-extremity procedure (b), applicability (c), and the exception (d); as amended at 88 FR 22917 (Apr. 14, 2023).
• 38 CFR 4.25, Combined ratings table — Table I procedure, conversion to the nearest degree divisible by 10 done once at the end, values ending in 5 adjusted upward.
• VA.gov, Current veterans disability compensation rates — 2026 table, effective December 1, 2025; dependent and added-amount method used in Example 4.

This article is educational material from an independent platform. It is not affiliated with, endorsed by, or operated by the U.S. Department of Veterans Affairs or the Department of Defense, and it does not provide accredited claims representation. VA award letters and the Code of Federal Regulations govern over any summary here.