VA Disability Ratings Explained
When you are injured during military service, you may not be able to work. Fortunately, the United States Department of Veterans Affairs offers compensation benefits for disabled veterans. This can include monthly payments. The VA rating system can also apply to mental health conditions.
Disabled veterans need to file a compensation claim to earn these VA disability benefits. This guide will break down the rating schedule that the VA uses to assign disability benefits, so you can prepare to make your claim.
What is a VA disability rating?
When making a disability claim within the VA, you will need to prove service-connection for your disability. Once your disability has been service-connected, the VA rates each granted condition. This veteran’s disability rating determines the extent of your compensation rates. VA disability ratings look at the severity of the disability to reflect your employment impairment.
These ratings are then expressed as a percentage based on how debilitating your condition is, which can include its effects on your health and general functionality. The percentages are assigned in 10% increments from 0%, as a non-compensable rating, to 100%. Although 0% is a non-compensable rating so you will not receive VA disability compensation for such a rating, it still entitles you to important benefits like priority health care.
Within the regulations governing VA disability ratings, you can search your condition to find the applicable VA diagnostic code. The diagnostic codes are broken down to the varying degrees in which condition affects your quality of life. Each code states the symptoms required for each level of severity and shows the applicable disability rating percentage.
Even if you qualify for two different diagnostic codes, the VA may only assign one code to use as the guideline for your appropriate rating. The VA must choose the code that will provide the highest disability rating. On the other hand, you may not be able to find your specific condition listed to locate the appropriate diagnostic code. In this situation, the VA will use the diagnosis and related code that is most similar to your condition. For this reason, when you receive a rating decision, the disabilities listed on the decision may not mirror the exact disabilities you claimed. The VA will notify you of this discrepancy by listing the disability you are rated under with a parenthetical of the original disability claimed so that you may ensure all claims were reviewed.
While VA disability ratings are often assigned for conditions incurred during military service, they may also be assigned for those aggravated by service. In these situations, the disability rating reflects the degree of severity beyond the level of severity at the time of entrance of military service, or as is determined to have existed at that time if it was not documented.
How is a VA disability rating assigned?
In assigning a disability rating, the VA will evaluate your conditions upon reviewing any medical evidence in your VA disability claims file or supplemental records that have been included in your claim. For an accurate rating, it is important to ensure the VA has your most current medical documentation.
Additionally, the VA looks to any applicable compensation and pension (C&P) exams when assigning a disability rating. It is important to attend all scheduled exams and to be as honest as possible with your examining physician because these are included in the reasoning for disability decisions.
In reviewing medical records and pertinent exams, the VA takes functional impairment into consideration to assign a proper disability rating. Functional impairment revolves around the ability to function under the ordinary conditions of daily life, including employment. But, evaluations looking at the lack of usefulness of a system or body part are also taken into consideration in terms of self-support. While your disability may prevent you from working full- or even part-time, you may be able to be self-sufficient at home.
If your disability impairs your functionality severely and is considered permanent in nature, you may receive a 100% disability rating for a singular condition. Some conditions and circumstances that may lead to a total disability rating include: permanent loss of use of both hands, feet or eyes; becoming permanently bedridden; becoming permanently helpless. This is to be distinguished from total disability based on individual unemployability (TDIU), which is considered a 100% rating too.
To be considered for a disability rating based on TDIU, you must be found to be unable to engage in substantially gainful employment due to your service-connected conditions. There are specific requirements for a TDIU rating. You must already have a 60% rating for one condition or a combined disability rating of 70%, with at least one condition rated at 40% or higher. But for these rating requirements of “one condition,” the VA will deem the following as a singular condition:
- One or both upper or lower extremities;
- Disabilities resulting from a common etiology or singular incident;
- Disabilities affecting a single system;
- Multiple injuries incurred in action; or
- Multiple injuries/disabilities incurred as a prisoner of war.
When the VA is rating disabilities, each condition only receives one rating. In other words, the VA will not assign different disability ratings for the same condition that may have been listed as different diagnoses throughout your medical history or claim for disability compensation. This is distinct from conditions which may be claimed as secondary to another service-connected condition. In that case, each condition would be entitled to separate ratings for the purposes of disability compensation.
Moreover, even if you are employed, you may still technically qualify for TDIU. If you are only engaged in marginal employment, that will not disqualify you from receiving a TDIU award if you meet the other requirements above. Marginal employment is shown if your earned annual income is below the poverty threshold for an individual, as established by the United States Department of Commerce. Sheltered employment, which involves accommodations provided by your employer, may also allow you to still qualify for TDIU.
Due to the likelihood of conditions changing over time, you may be subjected to review compensation and pension exams to ensure your current disability rating remains accurate. As such, it is important to notify the VA, whether independently or through legal counsel, of significant changes in your medical conditions. Reporting changes in your medical conditions may lead to staged ratings. This calls for the VA to rate your disability at varying percentages during different periods of time. For instance, if your medical records prove you are entitled to a 50% rating, but then there was a period of time where your symptoms qualify you for a 70% rating, the VA can assign those differences in percentages for the same condition for each of the appropriate time periods.
How are overall VA disability ratings determined?
While the VA assigns a disability rating for each service-connected condition, they also assign an overall combined rating. However, your combined rating will not necessarily be the sum of all your ratings. For example, you may receive a 30% rating for PTSD and a 20% rating for bilateral hearing loss, but your combined rating ends up at 40% rather than 50%. This is due to the calculations employed by the VA to combine your assigned disability ratings.
In general terms, the VA calculates a combined disability rating by considering your functional impairment as a result of your most disabling condition, then your other conditions in the descending order of severity. This means that for your first condition, or most disabling, the VA subtracts the percentage assigned – for example, 30% – from 100%. Since it is your only condition, you would be rated at 30% overall.
However, your 30% disability rating also caused the 100% starting point to step down to 70%. This may be referred to as the “Total Body.” So, if you then receive a rating of 20% for another condition, the VA determines your combined rating by subtracting the 20% from your new Total Body of 70%. As a result, this brings your Total Body down to 56%, or 70 – (20% * 70). Therefore, your combined disability rating is now 44%, or 30 + (20% * 70). But, because the VA rounds to the nearest 10, your decision would show your combined rating as 40%. This process continues for each additional condition with a disability rating.
The above shows the math behind combined ratings since it is often confusing to receive a 30% rating and a 20% rating without a 50% combined disability rating. You do not need to walk through the above steps each time though to determine your appropriate combined rating. Luckily, you can use the generated combined ratings tables or the combined disability rating calculator generated by the VA.
You also may have another factor, the bilateral factor, come into play when calculating your VA disability rating. The bilateral factor is an additional 10% that is added into your disability rating when a disability affects both arms, legs, or paired skeletal muscles. But the 10% is not additional in terms of how another 10% disability rating would be calculated. Instead, it is 10% of the combined value of the bilateral conditions. If the bilateral factor applies, it should be the initial calculation rather than starting with the highest rated individual condition as above. The below example illustrates the bilateral factor:
A veteran with a right foot condition and a left foot condition has a combined disability rating of 60%. This generates a bilateral factor of 6% (or 10% * 60%). The bilateral factor of 6% is then added – not combined through VA math – to the combined rating of 60%. Since ratings are rounded to the nearest 10, the 66% rating is rounded up to a 70% combined overall disability rating.
After the complicated process of calculating your disability rating is complete, the VA then determines your monthly compensation. But keep in mind that your monthly compensation may vary depending on whether you receive dependency benefits or other supplemental benefits (i.e., special monthly compensation), which are added into your disability benefits.
If you want help navigating the VA claims process, the team at Hill & Ponton is available to help. Our attorneys are experts on the veterans’ benefits claims process and VA compensation, as well as social security law. Contact us today for a free case evaluation.