How do VA disability ratings work and how are they combined?

The VA combined ratings table (38 CFR 4.25) combines multiple disabilities by calculating how much efficiency remains after each disability is applied, starting with the most severe condition.

How the Table Works

The table treats disability as a loss of efficiency. ¹ A person with a 60% disability is considered 40% efficient. When a second disability is added, it reduces the remaining efficiency. For example, a 30% disability reduces the 40% remaining efficiency by 70%, leaving 28% efficiency overall—meaning a combined rating of 72%. ¹

Steps to Combine Disabilities

• Arrange disabilities in order of severity, starting with the most disabling. ¹
• Look up the first two disabilities in Table I: find the highest rating in the left column and the other rating in the top row, then read where they intersect. ¹
• If there are three or more disabilities, take the combined value from step 2 (exactly as found in the table, not rounded yet) and combine it with the third disability using the same method. ¹
• Repeat for each additional disability in order of severity. ¹

Rounding Rules

Rounding happens only once, at the very end after all disabilities are combined. ¹²

• If the combined value ends in 0.1 to 0.4, round down to the nearest whole number. ²
• If the combined value ends in 0.5 to 0.9, round up to the nearest whole number. ²
• If the whole number ends in 1 to 4, round down to the nearest number divisible by 10. ²
• If the whole number ends in 5 to 9, round up to the nearest number divisible by 10. ²

Example

Three disabilities rated at 60%, 40%, and 20%: ¹

• Combine 60% and 40% using Table I = 76%
• Combine 76% with 20% using Table I = 81%
• Round 81% to the nearest 10 = 80% final combined rating

Special Rules

Bilateral factor: When disabilities affect both sides of the body (both arms, both legs, or paired muscles), add 10% of the combined value of those two disabilities before combining with other conditions. ²

Single disease entity: Disabilities from one disease (like arthritis or multiple sclerosis) are rated separately, then all disabilities are combined together. ¹

VA Manual guidance on rounding: The VA's internal manual confirms that rounding is the last step and must be done only once per rating decision. ²