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]
Notes of Decisions
Sanders v. Principi, 3 Vet. App. 334 (Vet. App. 1992).
“With application of the bilateral factor under 38 C.F.R. § 4.26 (1991), he has a combined service-connected disability rating of 50%.”
Foster v. Principi, 4 Vet. App. 35 (Vet. App. 1993).
“4% for the application of the bilateral factor under 38 C.F.R. § 4.26 (1991), for a combined total disability rating of 70%.”
Gregory v. United States (Fed. Cl. 2020).
· cites it 5× “See 38 C.F.R. § 4.26 (2019). 6 In the event that a service member is entitled to a disability for both legs, for both arms, or for “paired skeletal muscles,” the combined rating is required also to incorporate a “bilateral factor,” which consists of 10% of the raw combined score.”
09-18 816 (Board of Vet. App. 2017).
· cites it 2× “Under 38 C.F.R. § 4.26 , when a partial disability results from a disease or injury of both arms or legs, the ratings for the disabilities of the right and left sides will be combined as usual under 38 C.”
191018-38054 (Board of Vet. App. 2020).
· cites it 2× “See 38 C.F.R. § 4.26 , Table I. Moreover, with application of 38 C.”
McKelvey v. Shinseki, 555 F. App'x 972 (Fed. Cir. 2014).
· cites it 2× “McKelvey appealed the Board decision to the Veterans Court and contended that the Board erred in failing to apply the bilateral factor pursuant to 38 C.F.R. § 4.26 for the incomplete paralysis of the lower extremities, in denying his claim for service-connected prostatitis, and…”
Sharon A. Westphal v. Douglas A. Collins (Vet. App. 2026).
“119 The Board's pretense ignores VA's acknowledgement that, for all veterans, SMC(k) is warranted when the evidence shows that service-connected sexual dysfunction results in loss of use of a creative organ and when there is a service-connected condition resulting in infertility.”
10-46 356 (Board of Vet. App. 2015).
“For the purpose of determining the above, the following will be considered as one disability: 1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor set forth under 38 C.F.R. § 4.26 , if applicable; 2) disabilities…”
07-03 436 (Board of Vet. App. 2011).
“The application of the bilateral factor contained in 38 C.F.R. § 4.26 and the combined ratings table in 38 C.”
07-30 016 (Board of Vet. App. 2015).
“Under the interim revised criteria of DC 5293, effective September 23, 2002, IVDS is evaluated (preoperatively or postoperatively) either on the total duration of incapacitating episodes over the past 12 months, or by combining under 38 C.F.R. § 4.26 (combined rating tables)…”
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