VA Disability Percentage by Body Part: 15 Systems, Bilateral Factor

The VA disability percentage assigned by body part depends on the specific diagnostic code that governs that body part and the measurable criteria attached to it, not on the diagnosis by itself. Ratings run from 0% to 100% in 10-point steps, and the criteria vary widely: range of motion for a joint, pulmonary function scores for the lungs, blood pressure readings for hypertension, occupational impairment for a mental health condition. The VA Schedule for Rating Disabilities, in 38 CFR Part 4, organizes every ratable condition into 15 body systems, each with its own rules.¹

How a Body Part Becomes a Percentage

Every service-connected condition is meant to reflect the “average impairment in earning capacity” it causes. Each diagnostic code has thresholds that correspond to specific rating levels. Meet the criteria for 30% but not 50%, and you get 30%. When the evidence could fairly support either of two ratings, the rule is to assign the higher one if the condition more closely approximates that level. A 100% rating means the disability makes it effectively impossible for an average person to hold substantially gainful employment.¹

Two consequences follow. First, two veterans with the same diagnosis can end up at very different percentages because their functional loss differs. Second, the exam findings often matter more than the diagnostic label: it’s the measured degrees of flexion, the FEV-1 percentage, or the frequency of prostrating attacks that drives the number.

The 15 Body Systems

Subpart B of Part 4 groups all ratable conditions into these systems:¹

Musculoskeletal (§§ 4.40–4.73): joints, bones, muscles — back, knee, shoulder, hip, ankle.
Organs of special sense (§§ 4.75–4.84): eyes and vision.
Auditory acuity (§§ 4.85–4.87a): hearing loss and tinnitus.
Infectious diseases, immune disorders, and nutritional deficiencies (§§ 4.88–4.89).
Respiratory (§§ 4.96–4.97): asthma, sleep apnea, other lung conditions.
Cardiovascular (§§ 4.100–4.104): heart disease, hypertension.
Digestive (§§ 4.110–4.114): GERD, IBS, ulcers.
Genitourinary (§§ 4.115–4.115b): kidney and urinary conditions.
Gynecological conditions and disorders of the breast (§ 4.116).
Hematologic and lymphatic (§ 4.117): blood disorders, blood cancers.
Skin (§ 4.118): eczema, psoriasis, scars.
Endocrine (§ 4.119): diabetes, thyroid disorders.
Neurological and convulsive disorders (§§ 4.120–4.124a): migraines, neuropathy, radiculopathy, epilepsy.
Mental disorders (§§ 4.125–4.130): PTSD, depression, anxiety.
Dental and oral (§§ 4.149–4.150).

Musculoskeletal: Back, Knee, Shoulder, Hip, Ankle

Musculoskeletal ratings live in 38 CFR § 4.71a and are driven mostly by range of motion, functional loss from pain or weakness, joint instability, and ankylosis (a joint frozen in place).²

Spine and Back

Most back and neck conditions — degenerative disc disease, spinal stenosis, vertebral fractures, spinal fusion (codes 5235–5243) — are rated under a single general formula based on forward flexion and ankylosis:²

100%: unfavorable ankylosis of the entire spine.
50%: unfavorable ankylosis of the entire thoracolumbar spine.
40%: thoracolumbar forward flexion 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine.
30%: cervical forward flexion 15 degrees or less, or favorable ankylosis of the entire cervical spine.
20%: thoracolumbar forward flexion between 30 and 60 degrees, or combined thoracolumbar range of motion 120 degrees or less.
10%: thoracolumbar forward flexion between 60 and 85 degrees, or muscle spasm without abnormal gait.

Intervertebral disc syndrome can alternatively be rated on the frequency of incapacitating episodes, from 10% to 60%.

Knee

Knee conditions may be rated under several codes at once. Limitation of flexion runs from 0% to 30%, and limitation of extension can reach 50%. Joint instability is rated separately at 10%, 20%, or 30%. Ankylosis runs 30% to 60%. After a total knee replacement, the veteran gets a temporary 100% rating followed by a 30% floor, with higher ratings for chronic residuals involving severe pain or weakness.²

Shoulder and Arm

Shoulder ratings distinguish the dominant (“major”) from the non-dominant (“minor”) arm. Limitation of arm motion runs 20% to 40% for the dominant side and 20% to 30% for the non-dominant. Impairment of the humerus can reach 80% on the dominant side. Shoulder replacement carries a temporary 100% rating, then a 30% minimum for the dominant arm or 20% for the non-dominant.²

Hip and Ankle

Hip ratings depend on flexion limitation (10%–40%), ankylosis (60%–90%), or joint replacement (30% minimum, up to 100% during recovery, and up to 90% for prosthetic replacements requiring assistive devices). Ankle replacement carries a temporary 100%, then a 20% minimum, and up to 40% for chronic severe residuals.²

Arthritis

Degenerative arthritis confirmed by X-ray rates 10% when two or more major joints or minor joint groups are affected, and 20% when those joints also produce occasional incapacitating flare-ups. When arthritis limits motion in a joint but not enough to reach a compensable rating under the specific joint code, 10% is assigned for each affected major joint or group of minor joints.²

Mental Health

PTSD, depression, generalized anxiety, and other psychiatric conditions all share one general formula in 38 CFR § 4.130. The rating tracks the degree of occupational and social impairment, not the specific diagnosis:³

100%: total occupational and social impairment, with symptoms like persistent delusions, grossly inappropriate behavior, persistent danger to self or others, or intermittent inability to perform basic daily activities.
70%: deficiencies in most areas of life, with symptoms like suicidal ideation, impaired impulse control, or inability to establish effective relationships.
50%: reduced reliability and productivity, with panic attacks more than once a week, difficulty understanding complex commands, or impaired judgment.
30%: occasional decrease in work efficiency, with depressed mood, anxiety, weekly or less frequent panic attacks, or mild memory loss.
10%: mild or transient symptoms that decrease work efficiency only during significant stress, or symptoms controlled by continuous medication.
0%: a diagnosed condition without symptoms severe enough to interfere with functioning or require continuous medication.

Neurological: Migraines and Nerve Damage

Migraine headaches are rated at 0%, 10%, 30%, or 50% based on the frequency and severity of prostrating attacks. The 50% maximum requires very frequent, completely prostrating, and prolonged attacks producing severe economic inadaptability. A 30% rating applies when prostrating attacks occur about once a month.⁴

Nerve damage — peripheral neuropathy, radiculopathy — is rated by the specific nerve affected, the degree of paralysis (complete or incomplete), and whether it involves the major or minor side. The sciatic nerve reaches 80% for complete paralysis and runs from 10% (mild incomplete) to 60% (severe incomplete). The median nerve reaches 70% for complete paralysis on the dominant side; the ulnar nerve reaches 60%.⁵ Purely sensory involvement is generally rated at the mild level, or at most moderate.⁴

Respiratory: Sleep Apnea and Asthma

Under the current schedule, sleep apnea is rated 0% when asymptomatic, 30% for persistent daytime hypersomnolence, 50% when a breathing assistance device like a CPAP is required, and 100% for chronic respiratory failure with carbon dioxide retention or the need for a tracheostomy.⁶

Bronchial asthma runs 10% to 100% based on pulmonary function test results (FEV-1 and the FEV-1/FVC ratio) and treatment requirements. A 100% rating requires FEV-1 below 40% of predicted value, more than one weekly attack with respiratory failure, or daily use of high-dose systemic corticosteroids or immunosuppressives.⁶

The VA has proposed significant changes to respiratory ratings, including a new general rating formula based on pulmonary function testing and revised sleep apnea criteria focused on how well treatment controls the condition rather than simply whether a CPAP is prescribed.⁷

Cardiovascular: Heart and Blood Pressure

Heart conditions under 38 CFR § 4.104 are rated largely by METs (metabolic equivalents), a standardized measure of exercise capacity where one MET equals the energy cost of standing quietly at rest.⁸ Under the general heart disease formula:

100%: workload of 3.0 METs or less produces heart failure symptoms.
60%: workload of 3.1 to 5.0 METs produces symptoms.
30%: workload of 5.1 to 7.0 METs produces symptoms, or cardiac hypertrophy or dilatation confirmed by imaging.
10%: workload of 7.1 to 10.0 METs produces symptoms, or continuous medication is required.

Hypertension is rated separately by blood pressure readings: 10% for diastolic predominantly 100 or more (or systolic 160 or more), 20% for diastolic 110 or more, 40% for diastolic 120 or more, and 60% for diastolic 130 or more.⁸

Digestive: The Overlap Rule

An important rule sits at the top of the digestive system. Multiple gastrointestinal conditions with overlapping symptoms cannot be rated separately. When a veteran has GERD, IBS, and a hiatal hernia at the same time, the VA assigns a single rating based on the predominant disability, with elevation to the next higher level if the overall severity warrants it.⁹

Common ratings include hiatal hernia (up to 60% for severe symptoms with weight loss and anemia), irritable bowel syndrome (10%, 20%, or 30% by symptom frequency under updated 2024 criteria), and duodenal ulcers (up to 60% for severe disease with recurrent bleeding).¹⁰⁹

Hearing and Eyes

Hearing ratings are unusually mechanical. The VA uses a puretone audiometric test and the Maryland CNC speech recognition test to assign each ear a Roman numeral from I through XI. Those two numerals are plugged into a table that produces a rating from 0% to 100%. Because the process is score-driven, many veterans with noticeable hearing loss still land at 0% or 10%.¹¹ Tinnitus is a flat 10% whether it affects one ear or both.⁴

Vision disabilities under 38 CFR § 4.79 use three measurements: central visual acuity (Snellen chart), visual field (peripheral vision across at least 16 meridians), and muscle function (double vision). Ratings are based on corrected vision, and a single combined rating covers both eyes.¹² Eye diseases that don’t fit the acuity or field measurements can be rated on “incapacitating episodes” requiring treatment visits: 10% for one to two per year, 20% for three to four, 40% for five to six, and 60% for seven or more.

Skin

Dermatitis, eczema, psoriasis, and similar conditions share a general formula in 38 CFR § 4.118 based on skin coverage and treatment intensity:¹³

60%: lesions covering more than 40% of the body or exposed areas, or constant systemic therapy over the past 12 months.
30%: 20–40% coverage, or systemic therapy for six or more weeks.
10%: 5–20% coverage, or intermittent systemic therapy for less than six weeks.
0%: less than 5% coverage with only topical treatment required.

“Exposed areas” means the head, neck, and hands. Multiple skin conditions can be combined only if they affect separate areas of skin; if they overlap, only the highest rating applies.¹⁴

Endocrine: Diabetes

Diabetes mellitus under diagnostic code 7913 rates 20% when insulin or an oral medication combined with a restricted diet is required. A 40% rating adds the requirement of regulated activities. A 60% rating requires daily insulin injections plus episodes of ketoacidosis or hypoglycemic reactions requiring hospitalization or frequent provider visits.¹⁵

Complications like diabetic nephropathy are rated separately under the genitourinary system when they reach a compensable level, from 0% to 80% based on albuminuria, edema, kidney function decline, and lab values including BUN and creatinine.¹⁵

Combining Ratings From Multiple Body Parts

Percentages from different body parts are not added. The VA uses a combined ratings table built on the idea that a person cannot be more than 100% disabled. Disabilities are ranked from highest to lowest and combined sequentially, with each successive one applied to the remaining efficiency rather than the original whole.¹¹

An example: a 50% and a 30% rating produce a combined value of 65, not 80. Adding a 10% disability brings the total to 69, which rounds up to a final combined rating of 70%. Only the final number is rounded, to the nearest 10%.¹¹

The Bilateral Factor

When disabilities affect both arms, both legs, or paired skeletal muscles, the VA applies a bilateral factor that adds 10% of the combined value of those paired disabilities before combining with other conditions. The factor applies to compensable disabilities in paired extremities regardless of the specific location; a right hip condition and a left ankle condition both count as lower extremities.¹⁶

A 2023 rule change added an exception. If applying the bilateral factor would actually produce a lower combined rating than not applying it (something that can happen at higher overall percentages), the VA now removes those disabilities from the bilateral calculation and combines them separately to reach the most favorable result.¹⁷

When the Schedule Doesn’t Reach 100% But Pay Does

Veterans whose combined rating falls short of 100% can still be paid at the 100% rate through Total Disability Individual Unemployability (TDIU). It applies when service-connected disabilities prevent substantially gainful employment. Schedular eligibility requires either one disability rated at 60% or more, or a combined rating of 70% or more with at least one condition rated at 40%.¹⁸

For meeting those thresholds, certain groups count as a single disability: all disabilities of one or both arms, all conditions from a single accident, all conditions affecting one body system, and injuries sustained in combat or as a prisoner of war. Veterans who fall short of the percentage requirements but are still unemployable due to service-connected conditions can be referred for extra-schedular consideration.¹⁹

The Schedule Is Still Changing

The VA has been working through a phased modernization of the entire rating schedule. Updates to the dental, endocrine, eye, gynecological, and digestive systems have been completed. Proposed changes to the respiratory, auditory, and mental health systems have gone through public comment and await finalization. Full modernization is projected for fiscal year 2026, though the Government Accountability Office has noted the process has moved slower than expected.²⁰ Because criteria for a given body part can shift when a system is updated, it’s worth checking the current text of the diagnostic code before relying on older percentages.

1
eCFR. 38 CFR Part 4 – Schedule for Rating Disabilities
2
Cornell Law Institute. 38 CFR 4.71a – Schedule of Ratings, Musculoskeletal System
3
Cornell Law Institute. 38 CFR 4.130 – Schedule of Ratings, Mental Disorders
4
Cornell Law Institute. 38 CFR 4.124a – Schedule of Ratings, Neurological Conditions
5
eCFR. 38 CFR 4.124a – Diseases of the Peripheral Nerves
6
Cornell Law Institute. 38 CFR 4.97 – Schedule of Ratings, Respiratory System
7
VA News. VA Proposes Updates to Rating Schedule for Respiratory, Auditory, and Mental Disorders
8
Cornell Law Institute. 38 CFR 4.104 – Schedule of Ratings, Cardiovascular System
9
U.S. Department of Veterans Affairs. Board of Veterans Appeals Decision, Citation Nr 1020041
10
VA News. VA Updates Disability Rating Schedule for Digestive System
11
U.S. Department of Veterans Affairs. About VA Disability Ratings
12
U.S. Department of Veterans Affairs. Eye Conditions Disability Benefits Questionnaire
13
Cornell Law Institute. 38 CFR 4.118 – Schedule of Ratings, Skin
14
Federal Register. Schedule for Rating Disabilities: Skin
15
U.S. Department of Veterans Affairs. Board of Veterans Appeals Decision, Citation Nr 1813022
16
Cornell Law Institute. 38 CFR 4.26 – Bilateral Factor
17
Federal Register. Exceptions to Applying the Bilateral Factor in VA Disability Calculations
18
eCFR. 38 CFR 4.16 – Total Disability Ratings for Compensation
19
Cornell Law Institute. 38 CFR 4.16 – Total Disability Ratings for Compensation Based on Individual Unemployability
20
Veterans of Foreign Wars. Reevaluating the Rating Schedule: Examining VAs Efforts to Modernize Disability Benefits