Educational guides about the VA disability rating system, VA math, bilateral factor, DeLuca factors, and claims strategy.
How the general rating rules work
The guides in this group explain the rules that sit underneath every diagnostic code. They draw on Subpart A of 38 CFR Part 4, "General Policy in Rating" (§§4.1 through 4.31), on the musculoskeletal principles in §§4.40 through 4.59, on a few shared measurement tools used across several body systems, and on claims topics such as buddy statements, fully developed claims, and the PACT Act and Agent Orange presumptives.
The starting point is §4.1: the percentages "represent as far as can practicably be determined the average impairment in earning capacity" resulting from a condition in civil occupations. §4.10 bases evaluations on the ability of the body or a system to function "under the ordinary conditions of daily life including employment." Under §4.2, the rater reads each examination "in the light of the whole recorded history," and a report without sufficient detail is to be returned as inadequate.
Several rules govern close calls. Under §4.3, when a reasonable doubt arises about the degree of disability, "such doubt will be resolved in favor of the claimant." Under §4.7, the higher of two evaluations is assigned "if the disability picture more nearly approximates the criteria required for that rating." §4.21 adds that it is not expected "that all cases will show all the findings specified." §4.14 bars pyramiding: "the evaluation of the same manifestation under different diagnoses" is to be avoided. But except where the schedule provides otherwise, §4.25(b) has "the disabilities arising from a single disease entity" rated separately.
Combining is not addition. The combined ratings table in §4.25 works from remaining efficiency: in the section's own example, a 60% disability leaves a person 40% efficient, a further 30% disability takes 30% of that remaining 40%, and the result is 72%. Ratings are arranged in order of severity and combined one at a time, and the final value is converted to the nearest number divisible by 10, with values ending in 5 adjusted upward. That conversion "will be done only once per rating decision," after every disability has been combined.
The bilateral factor in §4.26 applies when partial disability affects both arms, both legs, or paired skeletal muscles. The two sides are combined, and 10% of that value is "added (i.e., not combined)" before any further combinations. It requires "partial disability of compensable degree in each of 2 paired extremities," and "arms" and "legs" mean the whole upper or lower extremity, so a thigh on one side and a foot on the other qualify. Under paragraph (d), a bilateral disability is taken out of the calculation and combined separately when that produces a higher combined evaluation.
For joints and muscles, §4.40 says "weakness is as important as limitation of motion" and that "a part which becomes painful on use must be regarded as seriously disabled." §4.45 lists factors including weakened movement, excess fatigability, incoordination, and pain on movement; these provisions are often discussed as the DeLuca factors. §4.59 recognizes "actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint."
The shared tools include the General Rating Formula for Mental Disorders in §4.130, the hearing tables in §4.85, the pulmonary function tests required for many respiratory codes under §4.96, METs testing for heart conditions under §4.100 and §4.104, and the voiding dysfunction formulas in §4.115a.