VA Disability Ratings: Criteria, C&P Exams, and Combining Ratings

The VA assigns disability ratings by matching your documented symptoms to criteria in a federal rating schedule, giving each service-connected condition a percentage from 0 to 100 in 10-point increments, then combining multiple conditions with a specific formula. Understanding how VA disability ratings are assigned matters because the final percentage controls your monthly tax-free compensation, which in 2026 runs from $180.42 at 10 percent to $3,938.58 at 100 percent for a single veteran with no dependents.¹

The Rating Schedule Sets the Criteria

Every rating decision flows from one federal regulation: 38 CFR Part 4, the Schedule for Rating Disabilities. The schedule groups conditions by body system — musculoskeletal, respiratory, cardiovascular, mental health, and so on — and assigns each recognized disease or injury a diagnostic code.² Under each code, the regulation spells out the symptoms, measurements, or test results that correspond to each percentage level.

The point of that structure is consistency. The schedule is designed to estimate the average loss in earning capacity a condition would cause in civilian life, so a veteran in Florida with a 40-percent-rated knee injury should receive the same evaluation as a veteran in Oregon with identical symptoms.² Rating officials at every regional office are bound by the same criteria.

How a Rater Turns Evidence Into a Percentage

Ratings run from 0 to 100 percent in 10-percent increments.³ A rater takes the medical evidence in your file and compares it against the criteria listed under your condition’s diagnostic code. For a knee condition, that might mean measuring exactly how far the joint bends and extends. For PTSD, it might mean evaluating how symptoms affect work, sleep, and relationships. More documented functional loss means a higher percentage.

Two rules push against the natural tendency to round down. When your symptoms sit between two levels, the VA is supposed to assign the higher one if your overall picture comes closer to that level’s criteria. And any reasonable doubt about the degree of disability gets resolved in your favor.⁴ These rules are worth knowing because they mean the VA is not supposed to default to the lower number when the evidence is close.

What a 0% Rating Means

A 0-percent rating means the VA acknowledges your condition is connected to your military service, but the symptoms don’t currently meet the threshold for paid compensation.⁵ It is not a dead end. A 0-percent rating qualifies you for VA health care for that specific condition and keeps the door open to a higher rating later if the condition worsens. Many veterans who eventually reach a paid rating started at zero.

The C&P Exam Is Where the Evidence Comes From

The Compensation and Pension (C&P) exam is where the VA gathers the medical evidence a rater will use. A clinician, sometimes a VA doctor and sometimes a contractor, examines you and records objective findings: joint range of motion measured in degrees, cognitive test scores, blood work, or whatever the diagnostic code requires. The exam is not a treatment appointment, so there are no prescriptions or referrals.

Duration varies. A single straightforward condition might take less than half an hour; multiple or complex conditions take longer. The examiner compiles a report that maps your symptoms against the rating schedule’s criteria, and the rater uses that report to decide your percentage. If the examiner does not document a symptom, the rater typically cannot consider it.

The most common mistake veterans make in a C&P exam is downplaying their symptoms. Many veterans are used to pushing through pain, and that instinct works against you here. If your knee locks up three times a week, say so. If anxiety keeps you from sleeping, describe the frequency and severity. The examiner needs an accurate picture of your worst realistic day, not a demonstration of toughness. Describe the effect on daily activities, employment, and relationships in concrete terms.

Missing a scheduled exam can result in a claim denial, and rescheduling with a contract examiner is limited; you typically get one reschedule within five days of the original appointment. If you have private medical records that support your claim, uploading them to the VA’s claims status tool or submitting them through an accredited representative before the exam helps ensure they are part of your file.⁶

How Multiple Ratings Are Combined

Most veterans have more than one rated condition, and the way the VA combines them surprises almost everyone. Two 30-percent ratings do not equal 60 percent. The VA uses what is sometimes called “whole person” math: it starts with the assumption that you have a 100-percent-efficient body and subtracts each disability from what remains.

Here is how the arithmetic works. A first disability rated at 30 percent leaves you at 70 percent efficiency. A second 30-percent rating is then applied to that remaining 70 percent. Thirty percent of 70 is 21, bringing your combined value to 51 percent, not 60. Each additional disability takes a percentage of a shrinking remainder, so each new rating adds less than its face value to your combined total.³

After all disabilities are combined, the VA rounds to the nearest multiple of 10. Values ending in 1 through 4 round down; values ending in 5 through 9 round up.³ A combined value of 51 rounds down to 50 percent; 55 rounds up to 60 percent. That final rounded number determines your monthly payment. Because each new disability chips away at a smaller remainder, reaching a combined 100 percent through the formula alone requires several individually high ratings.

The Bilateral Factor

If you have compensable disabilities on both sides of a paired body part, such as both knees, both shoulders, or both legs, the VA adds a small boost through the bilateral factor. After combining the ratings for the paired disabilities, the VA adds 10 percent of that combined value before folding the result into the rest of your calculation. The factor exists because disabilities on both sides of the body compound each other in ways a one-sided injury does not. If applying the bilateral factor would actually produce a lower combined rating than calculating the disabilities separately, the VA must use whichever method gives you the better result.⁷

Secondary and Presumptive Service Connection

Not every rated condition needs a direct link to an in-service event. A condition that develops because of, or is made worse by, an already service-connected disability can be rated on its own. This is called secondary service connection. If a rated knee injury causes you to develop a hip problem from years of compensating, the hip can be service-connected under 38 CFR 3.310.⁸

The same regulation covers aggravation. If a service-connected disability worsens a condition otherwise unrelated to your service, the VA can rate the degree of that worsening, but it needs a baseline showing how severe the non-service-connected condition was before the aggravation began. A medical opinion linking the secondary condition to the original disability is almost always necessary, and this is where many secondary claims succeed or fail. Some secondary connections are presumed by regulation: with a service-connected traumatic brain injury, for example, Parkinson’s disease, certain dementias, and depression are presumed to be caused by the TBI when they appear within specified timeframes.⁸

Presumptive service connection removes the burden of proving a link for specific conditions tied to specific exposures. If you served in a qualifying location during a qualifying period and later develop a listed condition, the VA presumes the connection. The PACT Act, signed in 2022, added more than 20 presumptive conditions for veterans exposed to burn pits and other toxic substances during Gulf War–era and post-9/11 service, including respiratory, kidney, pancreatic, brain, and reproductive cancers, along with chronic respiratory diseases such as COPD, pulmonary fibrosis, and constrictive bronchiolitis.⁹

The Act also expanded Agent Orange presumptives to include hypertension and monoclonal gammopathy of undetermined significance, and it established new presumptive exposure locations, including all U.S. and Royal Thai military bases in Thailand from 1962 through 1976 and parts of Laos, Cambodia, Guam, and American Samoa during specified periods.⁹ If you served in a covered location during a covered period, exposure itself is presumed.

Reaching 100% Without a 100% Schedular Rating

You don’t always need a 100-percent combined rating to receive 100-percent compensation. If your service-connected disabilities prevent you from holding a substantially gainful job, you can apply for Total Disability Based on Individual Unemployability, or TDIU. The VA pays TDIU at the same monthly rate as a schedular 100-percent rating.

To qualify on a schedular basis, you need either a single service-connected disability rated at 60 percent or more, or a combined rating of 70 percent or more with at least one individual disability at 40 percent. Disabilities that share a common cause, affect the same body system, or result from a single accident can be treated as one disability for purposes of meeting those thresholds. If you fall short of the numbers but can still show that service-connected disabilities make you unemployable, the VA can refer your case for extra-schedular consideration.¹⁰

One detail catches people off guard: marginal employment does not count against you. If your annual income does not exceed the federal poverty threshold, or if you work in a protected environment such as a family business, the VA does not consider that substantially gainful employment for TDIU purposes.

Separately, some injuries are so severe that even a 100-percent schedular rating does not adequately compensate for them. Special Monthly Compensation (SMC) provides additional payments above the standard 100-percent rate for losses such as a hand, foot, or eye, loss of use of a creative organ, deafness in both ears, or the need for regular aid and attendance.¹¹ SMC is not usually something you apply for separately; if the evidence in your file shows you meet the criteria, the VA is supposed to consider it automatically, though it does not always happen.

If You Disagree With the Percentage

If you believe your assigned rating is too low, or your claim was denied outright, three review options exist under the Appeals Modernization Act:¹²

A Supplemental Claim lets you submit new and relevant evidence that was not part of the original decision. This is the right path when you have additional medical records, a stronger nexus opinion, or new test results.
A Higher-Level Review sends the same evidence to a more senior reviewer for a fresh look. You cannot add new evidence, but the reviewer can identify errors the original rater made.
An appeal to the Board of Veterans’ Appeals goes before a Veterans Law Judge. You can request a hearing, submit additional evidence, or ask for a decision based solely on the existing record.

File within one year of the decision you are challenging. Miss that deadline and you can still file a Supplemental Claim later, but your effective date will typically reset to the date the new claim is received rather than the original filing date.¹³

Effective Dates Decide Back Pay

Your effective date determines when your monthly payments start and how much retroactive compensation you receive. The general rule is that the effective date cannot be earlier than the date the VA receives your claim.¹³

There is one major exception. File within one year of your discharge and the effective date goes back to the day after separation.¹³ This is one of the most consequential deadlines in the entire VA benefits system. A veteran who files 11 months after discharge gets back pay from day one. A veteran who files 13 months after discharge gets back pay only from the filing date, potentially losing thousands of dollars.

For increased rating claims, the effective date is the earliest date medical evidence shows the condition had worsened, as long as you file within one year of that date.¹³ If you are not ready to file a complete claim but want to lock in an early effective date, submit an Intent to File. It reserves your date for one year while you gather evidence.

Between the effective date and the date the VA finishes processing your claim, compensation accumulates as a lump-sum back payment. Claims often take months to decide, so that retroactive amount can be substantial by the time a rating is finally assigned.

1
U.S. Department of Veterans Affairs. Veterans Disability Compensation Rates
2
eCFR. 38 CFR Part 4 – Schedule for Rating Disabilities
3
Veterans Affairs. About Disability Ratings
4
eCFR. 38 CFR Part 4 – Schedule for Rating Disabilities – Section 4.3
5
U.S. Department of Veterans Affairs. Non-compensable Disability
6
U.S. Department of Veterans Affairs. Evidence Needed for Your Disability Claim
7
eCFR. 38 CFR 4.26 – Bilateral Factor
8
eCFR. 38 CFR 3.310 – Disabilities That Are Proximately Due to, or Aggravated by, Service-Connected Disease or Injury
9
U.S. Department of Veterans Affairs. The PACT Act and Your VA Benefits
10
eCFR. 38 CFR 4.16 – Total Disability Ratings for Compensation Based on Unemployability of the Individual
11
eCFR. 38 CFR 3.350 – Special Monthly Compensation Ratings
12
U.S. Department of Veterans Affairs. VA Decision Reviews and Appeals
13
Office of the Law Revision Counsel. 38 USC 5110 – Effective Dates of Awards