How it works: When you have service-connected disabilities on both sides of a paired extremity (both knees, both shoulders, etc.), the VA combines those conditions first, then adds a 10% bonus to that subtotal before combining with the rest of your disabilities. Enter at least two bilateral conditions to see the factor applied.
Bilateral Conditions
Affecting both sides of a paired extremity
Both knees · Both hips · Both shoulders · Both elbows · Both wrists / hands · Both ankles / feet
%
%
Other Conditions
Single-side or non-extremity
PTSD · Back / spine · TBI · Single-limb conditions · Tinnitus · Hypertension · Heart · Respiratory · Skin · Any non-paired-extremity condition
%
What qualifies as bilateral? Only disabilities of paired extremities (arms and legs) qualify under §4.26. Internal conditions, PTSD, back/spine, and single-limb conditions are not bilateral extremity disabilities. Both sides must be service-connected — having a non-SC condition on one side does not trigger the factor.
Source: 38 CFR §4.26. For the full combined rating formula, see General Rating Rules.