Why Isn't the Bilateral Factor Already in My Combined VA Rating?

First-person view of a pair of dusty hiking boots and both lower legs standing on a gravel dirt trail

The short answer

The Combined Ratings Table is not the bilateral-factor rule. 38 CFR § 4.26 is a separate step for paired extremities or paired skeletal muscles when each paired side has a compensable (not 0%) partial disability. Combine the paired sides first, add 10 percent of that combined value (add, do not combine that 10 percent), treat the result as one disability, then continue with 38 CFR § 4.25 whole-person combining. Paragraph (d) drops one or more bilateral disabilities out of that step when that produces a more favorable combined evaluation. Educational only; not accredited representation; no guaranteed outcome; independent of VA.

The mix-up

Veterans with ratings in both arms or both legs add two 10 percents and expect a jump, or treat a missing extra 10 percent as a Combined Ratings Table error. Those are different questions:

How VA combines two or more service-connected ratings (whole-person / table math) — 38 CFR § 4.25 and VA's About disability ratings page. That is a different note: Why Isn't My Combined VA Disability Rating Just the Sum?. This page does not rewrite VA's 50-then-30 example or the round-once rule.
Whether paired-extremity ratings get a 10 percent add-on first — this note. That step is 38 CFR § 4.26, not the Combined Ratings Table.
What the combined rating pays each month — a different page. Do not rewrite pay tables here.

What 4.26 actually does

eCFR current as of August 28, 2026 (Title 38 last amended August 27, 2026) prints § 4.26 this way. Except as provided in paragraph (d): 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. The rating for those disabilities, including the bilateral factor, will be treated as one disability for arranging in order of severity and for all further combinations.

The regulation's own example is the only custom stack this note prints. 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. That is § 4.26's example, not a veteran's file.

After that one-disability result exists, further combining uses the Combined Ratings Table. Send readers to the combined-rating note for whole-person math, rounding once at the end, and VA's 50-then-30 example. Live sources for that table: 38 CFR § 4.25 and VA — About disability ratings (last updated November 5, 2024).

Who it applies to

Paragraph (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. A 0% evaluation on one paired side does not meet that compensable-degree test.

Paragraph (a), definitions. The terms "arms" and "legs" are not meant to distinguish the arm, forearm and hand, or the thigh, leg, and foot. They relate to the upper extremities and lower extremities as a whole. The regulation's example: a compensable disability of the right thigh (amputation) and one of the left foot (pes planus) — the bilateral factor applies. The same is true whenever there are compensable disabilities affecting use of paired extremities, regardless of location or specified type of impairment.

Paragraph (b), four affected extremities. 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.

The April 16, 2023 most-favorable exception

Paragraph (d) says: 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. Citation on eCFR: [29 FR 6718, May 22, 1964, as amended at 88 FR 22917, Apr. 14, 2023].

VA published that exception as an interim final rule: Exceptions to Applying the Bilateral Factor in VA Disability Calculations, 88 FR 22914 (Apr. 14, 2023), RIN 2900-AR51, FR Doc. 2023-07426. Effective April 16, 2023.

What VA wrote there, tightly: the bilateral factor is applied when disabilities involving paired extremities are service connected. In limited cases it can yield a lower combined evaluation than if it were not applied to some or all bilateral evaluations.

VA’s published illustration — not a veteran’s file

The interim final rule's illustration: multiple disabilities that combine to 93 percent, plus two other 10-percent evaluations. Applying the bilateral factor: 10 and 10 combine to 19, then 1.9 is added (not combined) → 20.9, rounded to 21, then 93 and 21 combine to 94.47 → 94, adjusted downward to a final combined rating of 90 percent. Without the bilateral factor: 93 and 10 → 93.7 → 94, then 94 and 10 → 94.6 → 95, adjusted upward to 100 percent. That is VA's published illustration of an isolated problem, not a prediction for any file.

A second published illustration in the same IFR: combining 92 percent and 31 percent (31 from two bilateral disabilities at 20 and 10) versus combining 92 with 20 and 10 separately. With the factor, 92 and 31 combine to 94.48, rounded to 94, then adjusted downward to 90 percent. Without it, 92 and 20 combine to 93.6 → 94, then 94 and 10 combine to 94.6 → 95, adjusted upward to 100 percent.

In that IFR, VA said it is only at the low 90-percent level where the factor may reduce a combined evaluation. Do not treat that sentence as the current scope of paragraph (d).

The final rule, 88 FR 89307 (Dec. 27, 2023), FR Doc. 2023-28241, adopts the interim final rule as final without changes to 4.26(d). VA agreed the exception is not limited to 90 percent combined evaluations. The regulatory text applies whenever the combined evaluation is lower than what could be achieved by not including one or more bilateral disabilities in the bilateral factor calculation. VA also noted limited scenarios where a combined 80-percent evaluation could be increased to 90 percent.

VA disagreed that the amendment was merely a clarification or that prior decisions were clear-and-unmistakable-error or equitable-relief errors. Retroactive application is limited by 38 U.S.C. 5110(g). The effective date of the issue is April 16, 2023. This note does not tell readers they can CUE old math back to the original award date under this rule.

On review without a new claim: the IFR said VA will adjust all affected combined evaluations running on the effective date without requiring a claim from affected veterans or their representatives, and will provide notice under 38 U.S.C. 5104. If a veteran requests review based on this liberalizing issue, 38 U.S.C. 5110(g) and 38 CFR 3.114 apply: the effective date of an increase may be authorized from the effective date of the issue if the claim is received within one year of that date; if received more than one year later, the increase may be authorized for a period of one year prior to the date the claim is received. That is the FR language. It is not a promise that every veteran's rating was already changed.

Practical checklist (educational)

Write your individual ratings exactly as the decision lists them.
Check whether each paired side is a compensable partial disability. § 4.26(c) requires compensable degree on each of 2 paired extremities, or paired skeletal muscles.
Do not treat a 0% evaluation as triggering § 4.26(c).
Remember that "arm" and "leg" in § 4.26(a) mean the whole extremity. A compensable thigh rating and a compensable rating on the opposite foot can still be a paired-extremity pair.
Do not invent a custom stack. The only arithmetic this note reprints is § 4.26's own 60 / 20 / 10 / 10 example and VA's published Federal Register illustrations.
If the decision still disagrees with the live table after you separate the 4.25 step from the 4.26 step, that is a records question for accredited help — not a reason to invent a new formula. https://www.va.gov/get-help-from-accredited-representative/

What this note is not

Not a Combined Ratings Table / whole-person explainer. That is Why Isn't My Combined VA Disability Rating Just the Sum?.
Not a pyramiding / 38 CFR § 4.14 explainer. That is VA Pyramiding Under 38 CFR 4.14.
Not a pay calculator and not a promise of any monthly amount.
Not a promise that § 4.26(d) already raised your rating, or that every affected evaluation was adjusted on April 16, 2023.
Not a way to CUE old bilateral-factor math back to the original award date.
Not accredited representation and not affiliated with VA.

Educational only. This site is not a VSO, attorney, or claims agent. No guaranteed outcome. Confirm the live eCFR and Federal Register text before you act.

Sources

38 CFR § 4.26 Bilateral factor (eCFR current as of August 28, 2026; Title 38 last amended August 27, 2026)
38 CFR § 4.25 Combined ratings table (eCFR) — table math lives in /blog/combined-va-disability-rating
VA — About disability ratings (page last updated November 5, 2024)
88 FR 22914 (Apr. 14, 2023) — Exceptions to Applying the Bilateral Factor in VA Disability Calculations (interim final rule; effective April 16, 2023; RIN 2900-AR51; FR Doc. 2023-07426)
88 FR 89307 (Dec. 27, 2023) — same title, final rule (adopts the IFR without changes to 4.26(d); FR Doc. 2023-28241)
VA — Get help from an accredited representative

Quick answers

Is the Combined Ratings Table the same as the bilateral factor?

No. The Combined Ratings Table is 38 CFR § 4.25 and VA’s About disability ratings page. The bilateral factor is a separate step in 38 CFR § 4.26 for paired extremities or paired skeletal muscles. This note is the 4.26 step. Whole-person table math is /blog/combined-va-disability-rating.

When does 38 CFR § 4.26 apply?

Except as provided in paragraph (d), when a partial disability results from disease or injury of both arms, or of both legs, or of paired skeletal muscles. Paragraph (c) says the factor is not applicable unless there is partial disability of compensable degree in each of 2 paired extremities, or paired skeletal muscles. A 0% evaluation is not a compensable degree for that test.

What does “add, not combine” mean?

§ 4.26 says the ratings for the right and left sides will be combined as usual, and 10 percent of this value will be added (i.e., not combined) before further combinations or converting to degree of disability. The result, including the factor, is then treated as one disability for arranging in order of severity and for all further combinations.

What example does the regulation print?

§ 4.26’s own example: disabilities evaluated at 60 percent, 20 percent, 10 percent and 10 percent (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. That is the regulation’s example, not a veteran’s file.

Does a rating in one thigh and the opposite foot count?

Yes, when both sides are compensable. § 4.26(a) says “arms” and “legs” relate to the upper extremities and lower extremities as a whole, not a split between the arm, forearm and hand, or the thigh, leg, and foot. The regulation’s example is a compensable disability of the right thigh (amputation) and one of the left foot (pes planus).

What is paragraph (d)?

§ 4.26(d) is the most-favorable exception added in 2023. 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 bilateral disabilities are removed from that calculation and combined separately. The December 27, 2023 final rule (88 FR 89307) adopts the interim final rule without changes to that text and says the exception is not limited to 90 percent combined evaluations.

Did VA already raise my rating because of the 2023 rule?

The April 14, 2023 interim final rule (effective April 16, 2023) said VA will adjust all affected combined evaluations running on the effective date without requiring a claim, and will provide notice under 38 U.S.C. 5104. That is not a promise that every veteran’s rating was already changed. If a veteran requests review based on this liberalizing issue, 38 U.S.C. 5110(g) and 38 CFR 3.114 apply.

Can I treat old bilateral-factor math as CUE back to the original award?

The December 27, 2023 final rule says VA disagreed that the amendment was merely a clarification or that prior decisions were clear-and-unmistakable-error or equitable-relief errors. Retroactive application is limited by 38 U.S.C. 5110(g). The effective date of the issue is April 16, 2023. This note does not tell readers they can CUE old math back to the original award date under this rule.

Choose your free next step

Look up another condition, or get the printable Secondary Conditions Checklist by email.

Look up another condition

or email the checklist

Want to save this and export a packet later? That's the $59 pass.

Educational only. Not a VSO, attorney, or claims agent. Not affiliated with VA. No guaranteed outcome. Confirm the live eCFR § 4.26 text, 88 FR 22914, and 88 FR 89307 before you act. Sources: 38 CFR § 4.26 (eCFR current as of August 28, 2026); 38 CFR § 4.25; VA.gov About disability ratings (November 5, 2024); 88 FR 22914 (Apr. 14, 2023); 88 FR 89307 (Dec. 27, 2023); VA.gov Get help from an accredited representative. This article does not invent ratings, pay amounts, or a custom combined stack beyond the regulation’s own example and VA’s published Federal Register illustrations.