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Bilateral Factor


Guest jangrin

Question

Guest jangrin

Could some one figure the total disability including the bilateral factor on these upper and lower extremities?

Veteran is rated at

left leg/foot=40%

right leg/foot=10%

right arm/hand=10%

left arm/hand=10%

Thank you.

Jangrin

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TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF

CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS

PART 4_SCHEDULE FOR RATING DISABILITIES--Table of Contents

Subpart A_General Policy in Rating

Sec. 4.26 Bilateral factor.

When a partial disability results from disease or injury of both

arms, or of both legs, or of paired skeletal muscles, the ratings for

the disabilities of the right and left sides will be combined as usual,

and 10 percent of this value will be added (i.e., not combined) before

proceeding with further combinations, or converting to degree of

disability. The bilateral factor will be applied to such bilateral

disabilities before other combinations are carried out and the rating

for such disabilities including the bilateral factor in this section

will be treated as 1 disability for the purpose of arranging in order of

severity and for all further combinations. For example, with

disabilities evaluated at 60 percent, 20 percent, 10 percent and 10

percent (the two 10's representing bilateral disabilities), the order of

severity would be 60, 21 and 20. The 60 and 21 combine to 68 percent and

the 68 and 20 to 74 percent, converted to 70 percent as the final degree

of disability.

(a) The use of the terms ``arms'' and ``legs'' is not intended to

distinguish between the arm, forearm and hand, or the thigh, leg, and

foot, but relates to the upper extremities and lower extremities as a

whole. Thus with a compensable disability of the right thigh, for

example, amputation, and one of the left foot, for example, pes planus,

the bilateral factor applies, and similarly whenever there are

compensable

[[Page 370]]

disabilities affecting use of paired extremities regardless of location

or specified type of impairment.

(B) The correct procedure when applying the bilateral factor to

disabilities affecting both upper extremities and both lower extremities

is to combine the ratings of the disabilities affecting the 4

extremities in the order of their individual severity and apply the

bilateral factor by adding, not combining, 10 percent of the combined

value thus attained.

© The bilateral factor is not applicable unless there is partial

disability of compensable degree in each of 2 paired extremities, or

paired skeletal muscles.

hope this helps. since the one disability is much higher than the other one for your left left side i guess they will add the two together and add ten like they did in the example makinng your left side 60 percent and your right side 20 percent plus the 10 for bilateral to 30 percent. using VA math thats 72 percent. At least thats the way it looks according to the schedule that they use above for bilateral conditions. as they combine the ratings and add 10 to it 40+10+10=60 and 10+10+10 =30 that equals 72%

Anyone else see it as different? it might need to be double checked.

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Guest jangrin

Tower_rat,

This is so confusing. I have been reading the CFR for the bi-lateral factor, and I thought it means to combined the feet together and combine the hands. You know upper and lower extremities. But maybe it does mean left side right side. I tjhought it would work like this.

So lower would be 40 plus 10=50 plus 10percent=5 grand total=55% for lower

Upper would be 10 plus 10=20 plus 10percent=2= grand total 22% for upper

But then it says to combined all togther=so would that be 40 + 10 + 10+10= 70 plus 10% added=77%

It comes out the same either way-so I'm not sure if this is right ???? Too confusing !!!!! B)

I still don't think either of us is doing this correctly. ANYBODY ELSE HAVE ANY IDEAS???

Jangrin

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Well you came up with better than i did. At least the 77 would be rounded up to 80. Your right though, im not sure if its correct or not. In the CFR it said something like left and right side combine and add ten to each side but, its so confusing the way that they do it. Maybe they will just give you the schedular 100% and be done with it. Wouldnt that be nice B)

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Guest jangrin

Tower,

I'm just trying to figure out how they do this. I think this is how my husband should be rated when his claim is finally done. It is suppose to be at the raters now he had his C&P 2 months ago. So he should be hearing someting soon. The C&P exam gave a dx of peripheral neuropathy and I think this is how it should turn out, but you know the VA it may not.

Anyway we couldn't figure it out and I was wondering if anyone really understood this bi-lateral stuff. It is complicated and is not very clear. But it would be nice if it turns out that way. Where does it talk about rounding up or rounding down on the ratings? Do you know?

Thank for your help and ideas.

Jangrin

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I don't have a answer either, but have a question, also, on this subject. I was going through some of my VA papers, as I am appealing a EED of my diabetes, but anyway, the question is: I received a increase of sorts on December 16, 2003, when I went from 70% PTSD with TDIU P&T, up to 100 scheduler 100% P&T for PTSD, Panic Disorder, with Agoraphobia, so did that mean I got 100% for Panic Disorder, with Agoraphobia, as 70 and 30% by VA math doesn't add to 100%, by VA math I would of had to gotten at least a 90% rating, as 80% of the that 30% is 24, so that would of equaled a 20% rating increase and 90% of 30% is 27% should of gotten me the other 30% to equal a 100%, but I was never told anything about it at the time, and actually didn't know how they added things up back then. I don't even know if I did it right now. If that is the case, shouldn't that have been rated separately, as PTSD, and Panic Disorder, with Agoraphobia are separate issues, as I have read cases where Veterans have received 100% for Agoraphobia all by itself, or am I reading this wrong, as I am a little paranoid with the VA system, as they tried to screw me over on many issues over the years.

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I think I read on this forum somewhere that when you have PTSD with some of the other disabilities ie depression, agoraphobia, panic disorder that they may rate them all together or lump them together even though you can get a 100 percent for a seperate rating on each of these by themselves. Thats just my experience from it. Im sure there are some people here that know the exact regulations for it maybe they will get in on this topic

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Guest jangrin

Frosty,

I think this is one of those situations, where you are going to have to type or scan the award letter word for word so the experts here can read what it actually says. Sometimes a word missing can make all the difference.(of course leave off any personal info like name, SS#, address, etc.) I would think that it would only be the last part of the letter that states award or findings.

I'm sure if you do that, the forum will be able to tell you exactly what happened. You may have one rating for 100% or you may having multiple ratings that equal 100% or more.

Jangrin

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Could some one figure the total disability including the bilateral factor on these upper and lower extremities?

Veteran is rated at

left leg/foot=40%

right leg/foot=10%

right arm/hand=10%

left arm/hand=10%

Thank you.

Jangrin

I followed the rating table that I got (4.25) off of title 38 I believe it is part 4. If I am reading this right

40+10=46%

46+10=51%

51+10=56%

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jangrin

For once that is a easy task, as all it says word for word is:

Evaluation of post traumatic stress disorder and panic disoder with agoraphobia which is currently 70 percent disabling, is increased to 100 percent effective December 16, 2003.

Now after reading this sentence word for word, like you said, I can see where they lied, as my panic disorder with agoraphobia, wasn't diagnose until I had a C&P EXAM in March of 2004, as this award letter was dated July 16, 2004, but they acted like I had PTSD, panic disorder with agoraphobia all awarded at the same time, which is wrong. another question, I just thought about I had PTSD with TDIU P&T back to May of 1998, then Dec, 2003, I got the 100% scheduler P&T, for that 10 year rating, which year would the VA go by 1998 or 2003. I am thinking about the DIC part for my wife, in case I die of something not service-connected.

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Guest jangrin

Frosty69,

Hello, I just got to thinking about a post I read here at Hadit the other day. I can't remember who it was that posted it but I remember it was about diagnosing and rating mental awards.

If I have this correctly, the VA does NOT award mental and physical the same way. If you have multiple mental conditions the VA combines the condition for one (1) overall rating. Unlike physical conditions, most have individual ratings and then are rated according to the VA rating scale.

So I think the VA agreed that you had the agoraphobia and panic disorder and when combined with the prior diagnosis of PTSD, they put you at 100% scedular. (thats good).

But to what date, I would think that it should go back to 1998 when you were PTSD 70% TDIU P&T. Because at that time you were still unemployable and TDIU makes you 100% uemployable. I not for sure on this but thats my take. You might want to ask John999,Carli, Berta, Vile17. They have more experience in this. But any way you look at it 100% is good.

There have been some posts lately about different illnesses associated to PTSD, such as hypertension, heart disease. If you are having any other medical problems you might want to see about getting them possibly service connected.

Good Luck, Jangrin B)

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Guest jangrin
I followed the rating table that I got (4.25) off of title 38 I believe it is part 4. If I am reading this right

40+10=46%

46+10=51%

51+10=56%

Hi JohnM,

I still think we have this wrong. But I'm not a wiz on the excel spread sheet. SO I used the "scrate" calculator and I came up with as follows:

40+10+10+10=70 + 10% (7)=77% = 80%

The CFR said to take all extrmities add together and then add 10%. Now if there were other rating for example lets say...

PTSD - 70%

PN left hand - 10%

PN right hand- 10%

PN left foot -10%

right foot -10%

hypertension -10%

I think it would be 70% + 44% + 10% =84.88 rounded down to 80%

70=ptsd

44=PN plus 10% for bilateral

10=hypertension

70 % is highest, then PN w/bilateral and the 10% hypertension as the lowest rating.

Anyway, still very confusing, there are some former rating specialists that are here at hadit, maybe one of them will see this post or maybe someone else has figured this out. I'm still not sure. B)

I'll try reading it again for the four hundreth time. :) and Berta expects us to understand all those legal decisions......right..... :)

Thanks again,

Jangrin

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angrin

thanks for the information, I think you are right about the mental conditions, can be only rated once, no matter what it might be, as I sorta remember reading something about that a while back, but with my memory problems, I don't think about something, unless someone says something, or I happen to read it somewhere. As for the condition that might be secondary to PTSD, like Hypertension, GERD, sleep apnea, and a whole bunch of other things, I have filed for everything, that I feel might be connected to the PTSD, and the diabetes, which is service connected, but the VARO, has denied everything at least once, sometimes 2-3 times, some cases are at the BVA, others are out there in VA land somewhere, most I never received a C&P exam, just a denial, others the VA doctors have ruled in my favor, but the RO, stills Deny's, saying that the Doctor didn't do it right, or that they just went by what i said, the old lay person denial they like the quote, one thing the VARO has never answer me is why as i a person with the symptoms, and know what I feel like, are consider a lay person, and can't make medical statement, but a VA adjudicator, with no medical knowledge, can deny what a doctor says, and that is ok.

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  • HadIt.com Elder

JohnM was right as far as he went, but he did not finish the calculations.

Jangrin, 38 CFR does NOT say "add them all together" it says "combine them', (which is VA math). Take up where JohnM left off, then add 10% of that amount, and you get 56 + 5.6 = 61.6%, which rounds to 60%, if there are no other ratings. If there are other ratings (non bilateral and less than the 61.6%) then they get combined with the 61.6%, since bilateral ratings are ALWAYS computed first; BUT ratings are combined with the largest first, in descending order.

If there was a non-bilateral rating that was bigger than the bilateral rating calculated under the above rules, then that would be used first. In that case, the bilateral aspect is less helpful, since it is affecting a smaller base amount.

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Guest jangrin
JohnM was right as far as he went, but he did not finish the calculations.

Jangrin, 38 CFR does NOT say "add them all together" it says "combine them', (which is VA math). Take up where JohnM left off, then add 10% of that amount, and you get 56 + 5.6 = 61.6%, which rounds to 60%, if there are no other ratings. If there are other ratings (non bilateral and less than the 61.6%) then they get combined with the 61.6%, since bilateral ratings are ALWAYS computed first; BUT ratings are combined with the largest first, in descending order.

If there was a non-bilateral rating that was bigger than the bilateral rating calculated under the above rules, then that would be used first. In that case, the bilateral aspect is less helpful, since it is affecting a smaller base amount.

THANK YOU Wallyg,

This has been driving me crazy. I just couldn't grasp the concept at all. The VA math is the key and JohnM is a very smart man.

Thank you again. This has come on the forum board many times, and I went back and did a search but just didn't get it. DUH, now I do . Thanks again! :)

Jangrin B)

Edited by jangrin (see edit history)
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Hi all,

I'm not sure if this will help you out but, this is the easiest way to explain it withoout getting too technical.

step 1: take all of your rating percentages put them in order highest to lowest. They all have to be multiplied and subtracted seperately, do not add them first.

step 2:When you multiply the 2nd, 3rd, 4th ratings, it is by whats left over of the 100% (each time) not the total 100%

step 3: you should now have a number, of course with a decimal if you have lots of ratings.

step 4: Add pecentages together round up and you have your answer

Example:

ratings...a,b,c,d etc stand for whatever your diagnosis is like, hypertension etc.

a-70 ok 70% of 100% is 70%......whats percentage is left 30%, you multiply your next percentage by

the percentage that is left. Do the same thing for each rating %.

b-20 20% of 30%(left over from inital 100%) is 6%...... subtract 30%-6% is 24%, use 24% for next one.

c-10 10% of 24% is 2.4%........ subtract 24%-2.4% is 21.6%, use 21.6% for next one

d-10 10% of 21.6% is 2.16%....subtract 21.6%-2.16% is 19.440%, use 19.440% for next one

e-10 10% of 19.440% is 1.944%...subtract 19.44%-1.944% is 17.496%.

No take all of your percentages you got multiplying and add them together.

70% + 6%+2.4%+2.16%+1.944%= 82.504% using the rounding system to the nearest 10's it is 80%

You just have to remember to use whatever amount is left over from the calclation before.

I really hope this helps alt least one person.

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