THE VIDEO: In this week’s video, Robert Chisholm sits down with CCK’s Managing Attorney, Jonathan Greene, to talk VA disability ratings – how they’re determined for individual disabilities and how to calculate your own Combined Rating.
THE EXAMPLE: A veteran has Post Traumatic Stress rated 50%, tinnitus rated 10%, and bilateral hearing loss rated 10%. One might assume that that veteran’s combined rating would be 70% because 50 + 10 + 10 = 70, but this is not the case. Instead, the rating is calculated like this:
Look at the highest rating (PTS at 50%) first. If the veteran is 50% disabled, then (according to VA) he/she is 50% NON-disabled.
100% – 50% disabled = 50% NON-disabled
So, according to VA’s rules, the next rating (tinnitus at 10%) only comes out of the remaining 50% that is NON-disabled.
10% of 50% = 5% [OR .1 x .5 = .05]
We then add that 5% to the 50% to get 55% disabled. The remaining, NON-disabled percentage than becomes 45%.
5% + 50% = 55% disabled 100% – 55% = 45% NON-disabled
The next rating (bilateral hearing loss at 10%) only comes out of the remaining 45%.
10% of 45% = 4.5% [OR .1 x .45 = .045]
We then add 4.5% to 55%, getting 59.5%. Since there are no more disabilities to combine, we can round to the nearest multiple of 10 to find the veteran’s final combined rating. Because it is greater than 55%, we round up to 59.5% (if it was 52% or 54.5%, for example, we would round down) and the veteran will receive compensation at the 60% level.
4.5% + 55% = 59.5% ≈ 60% disabled
Robert: Hi. This is Robert Chisholm from Chisholm Chisholm & Kilpatrick. With me is Jonathan Greene, also from Chisholm Chisholm & Kilpatrick. We’re going to talk today about the rating schedule. So, Jon, in general terms, what is the VA rating schedule?
Jon: The VA rating schedule is – well, it’s designed to compensate disabled veterans for the average impairment in earning capacity. So, it’s to give them compensation which is a dollar amount for how severely they are disabled.
Robert: And are veterans awarded specific compensation based on how disabled they are for the specific conditions?
Jon: Yes. For each condition that they have that is found to be service connected, meaning is somehow related to their active duty military service, they will get an assigned rating which corresponds to the severity of that condition.
Robert: Is my understanding correct that, generally speaking, and I know there are some exceptions that a veteran is rated anywhere from 0% percent to 100% and a 0% rating means it’s service connected but they don’t receive any monthly benefits, whereas a 100% rating, generally speaking, in 2017, means about $3,100 a month.
Jon: Yes, that’s correct. So, you get an assigned rating ranging from 0 to 100, generally speaking. And yes, the dollar amount would be anywhere from 0 to – yeah, I think of it as around $3,000.
Robert: And are there specific codes that tell the VA how to rate each disability?
Jon: That’s right. So, if a veteran is found to be service connected for a condition, what VA would do is look up the corresponding diagnostic code, and that diagnostic code would have levels of severity that correspond to a percentage and they would assess how severe this veteran’s disability is and then try to match it up with the correct disability rating under that diagnostic code.
Robert: What if there isn’t a specific diagnostic code that corresponds to the veteran’s disability?
Jon: What they would do is they try to match it up with the closest thing. So, what they call rate by analogy so they would find a diagnostic code that kind of matches the manifestation of symptoms of that condition.
Robert: So, one could have a rating theoretically for like post-traumatic stress, also have a rating for an injury to the knee and also have a rating theoretically for a through and through wound, gunshot wound.
Jon: That’s right. You can be rated for as many disabilities as you have that are related to service.
Robert: There’s something called “VA math” and as I understand, it has to do with if a veteran has multiple disabilities and multiple ratings for those disabilities, VA just doesn’t add them up. They have a special formula that they use.
Jon: That’s right. So, people complain about this all the time. You don’t just add up the different percentages that you have, it’s what appears to be a fairly complicated calculation. So, what they do is if you are rated for one disability, you get the percentage assigned for that one disability but when you get rated for a separate disability, what they do is that separate disability would be a calculation of the percentage that is not disabled after the first disability rating. It probably is easier if we look at an example or two.
Robert: So, let’s take an example of veteran who has post-traumatic stress and is rated 50%. Let’s suppose that veteran’s also rated 10% for tinnitus, which is ringing in the ears, and 10% for bilateral hearing loss. So, a 50, a 10 and a 10 using straight math is 70 but how do we do that in VA math?
Jon: Right. So, the results, unfortunately, is not 70 because you’re not just adding the 50, and the 10 and the 10. What happens is you take the 50% so that veteran, after the 50%, is considered to be 50% disabled. There is therefore 50% of that veteran that is not disabled, so when you look at the 10% for the tinnitus, that 10% only comes out of the amount that is not disabled. So, 10% of 50% is 5%. So, you add the 5% to the already 50% and you get 55%. If you stopped there, you would round up and that veteran would get paid at the 60% disability rating. However, we have that other 10%, so that is 10% of the remainder that is not disabled, which is 45%. So, 10% of 45 is 4.5. So, you add 4.5 to 55 and you get, rounding up, you get 59.5 or 60. So, that veteran will get paid at 60 as opposed to 70.
Robert: So, using the example we’ve just had, you take the highest rating first, so that was the 50% and you say, well, the veteran is 50% impaired and 50% not impaired then you look at the next highest number, in this case, another 10%. You’ll get 10% of the remaining 50%. So, it gets harder and harder using that formula to get the rating increased.
Jon: Right, exactly. The higher you go, the more difficult it is to make the next 10% increment. So, if you have a 90% disability rating, in order to get – if you have an even 90% disability rating, in order to get a 100%, in order to get to the next 10% increment, you need to have another service-connected condition that is at least 50% because that will get you to 95 which will round up to 100. So, you’re already at 90%, you’re probably very severely disabled with a lot of disabling conditions and you still need another severe disability rated at 50% in order to get the full compensation.
Robert: I understand there’s a special procedure when a veteran has a disability that affects either both arms or both legs, can I ask you about what that procedure is?
Jon: Sure. They call it the bilateral factor. So, if a veteran is service connected, has disabling conditions, both arms or both legs or paired skeletal muscles, they get an additional 10% on top of whatever the combined rating would be for both arms, both legs, for example.
Robert: And when you’re talking about the combined rating, that’s what we were just discussing.
Jon: Right. So, what you do is if you have – if the bilateral factor is in play, so if there’s a veteran who has service-connected disabilities at both of their upper extremities and say they have a whole host of other things, what you do is you want to address the bilateral conditions first. So, if the veteran is rated at 20% for one arm and 20% for the other arm, that would result in a 36% disability rating but before you round up or down, you would then add an additional 10% of the 36. So you add another 3.6 or 4 which would get you to an even 40, 36 plus 4. So, for that bilateral piece, they would get rated at 40% and then you start with the other conditions using the combined method that we had just talked about.
Robert: So this seems very confusing to veterans and it’s always been confusing to me and I’ve been doing this for over 25 years, but there is a table that sort of walks you through this in the VA code of regulations, correct?
Jon: That’s right. So, you don’t need to do the math in your head. What you would want to look at is 38 CFR 4.25 and use that table which has along the top, it has numbers from 0 to 100 in increments of 10. Along the other side, it has numbers in increments of 1 all the way up from 0 to 100 and you can match up and do your combined ratings that way. That’s a lot easier. But, yes, it is very confusing and it’s also very frustrating. It’s possible that veterans will have disabling conditions that if you add them up, simply add them up, they’re going to be well over 100% but they’re not getting paid at over 100%, they’re only getting paid at 70, 80 or whatever it is.
Robert: Does the VA ever make mistakes with just this calculation?
Jon: Yes. I think that VA does a good job with the calculations. What you want to look at is the VA rating decision and in the last few pages just contains what we call a code sheet and the code sheet will show – it doesn’t exactly show but it lists the conditions and lists the percentages and then it shows you what the combined rating is. It is possible that VA will get these ratings wrong. It is possible that VA will not account for the bilateral factor or will feel that the bilateral factor is not relevant to this case when in fact, it is. So, you definitely want to be double checking that.
Robert: Thank you very much, Jon. This is Robert Chisholm and Jonathan Greene from Chisholm Chisholm & Kilpatrick.
Jon: Thank you.