Since the best VA rating you can get is 100% permanent and total, our VA disability lawyers always consider our veterans’ full medical history to see if you have multiple conditions that add up to 100%.
The principle of secondary service-connected disabilities is used to establish a service connection for disabilities that were caused by other disabilities or their treatment. Complementary disabilities, on the other hand, are disabilities that arise from the same event or set of circumstances.
The VA disability calculator treats secondary service-connected disabilities and complementary disabilities the same. However, because complementary disabilities stand on their own, they may have higher individual ratings. It is sometimes easier to go from a lower disability percentage to total disability using complementary disabilities than secondary service-connected disabilities.
In this article about common VA ratings that add up to 100%:
- The VA’s Process for Rating Complementary Disabilities
- Find Individual Ratings on the Ratings Schedules
- Rules for Assigning Individual VA Ratings
- Avoid of Pyramiding in Assigning Ratings
- Complementary Disabilities vs. Secondary Service-Connected Disabilities
- Five Common Complementary Conditions That Add up to 100% VA Disability
- Estimate how much you’ll get with the VA Disability Calculator
The VA’s Process for Rating Complementary Disabilities
Before delving into combinations of conditions that add up to 100% disability, let’s review how the VA rates complementary disabilities. Generally, the process for arriving at an overall disability rating from individual disabilities has two steps:
- Determining individual ratings for each disability using the VA’s rating schedules.
- Applying the VA disability calculator to aggregate the disability ratings together.
This article will address the first step of this process. For more information on applying the VA disability calculator, you can read our article on the disability calculator and combined ratings.
Find Individual Ratings on the Ratings Schedules
The ratings schedules are organized by body system. For example, back and intervertebral disc disorders fall under the disability ratings for the musculoskeletal system.
The underlying principle of the rating schedule is that disability percentages are assigned based on symptoms presented. Thus, if you have a disability that is not listed in the rating schedule, the VA will use the closest analogous rating schedule that presents the most similar symptoms. In other words, the VA does not necessarily limit itself based on the name of your condition. Rather, it cares primarily about the effects of your condition.
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Rules for Assigning Individual VA Ratings
When assigning individual disability ratings, the VA’s regulations instruct claim examiners and the Board of Veterans’ Appeals to try to resolve all doubts in favor of veterans. This means that in any denial, the evidence to deny a claim must outweigh the evidence to grant a claim. If the evidence on both sides is equal, the claim must be granted.
Moreover, if any reasonable doubt is raised in examining evidence of the extent of a disability, the doubt must be resolved in favor of the veteran. These rules can come into play in many circumstances. For example, if the record has conflicting medical opinions, the VA should favor those opinions that support the disability claim if the opinions are roughly equal. Likewise, if the veteran’s testimony about how the disability affects their daily life conflicts with the opinion of a VA doctor, the veteran’s lay testimony should be favored as long as it is credible.
Another rule that favors veterans requires the VA to assign a higher rating if a veteran’s symptoms meet the criteria of two different disability ratings. Occasionally, this is used to categorize a veteran’s disability on two different rating tables.
This rule is applied when a veteran’s symptoms meet some but not all the criteria for a higher rating. For example, two of the symptoms for the highest rating for gastroesophageal reflux disease (GERD) are bloody vomit and stool. If a veteran has all the other symptoms for the highest rating except for bloody vomit and stool, the VA is required to grant a higher rating provided it matches the overall symptomatic picture better than the lower rating for GERD.
Avoid of Pyramiding in Assigning Ratings
When evaluating individual ratings, the VA disability pyramid rule can limit the assigned rating percentage. Pyramiding occurs when one disability is assigned multiple ratings. For example, a spinal disc injury rated under the range of motion rating schedule and the debilitating flare-up rating schedule would violate the anti-pyramiding rule. Similarly, assigning a rating for both hiatal hernia and GERD produced by the hiatal hernia is an example of prohibited pyramiding.
There are circumstances where the VA may misapply its pyramiding rule to the disadvantage of the veteran. When different disabilities present overlapping symptoms, the VA sometimes misapplies its anti-pyramiding rules to deny benefits to one of the disabilities.
This problem is particular to complementary disabilities like traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Even though one is a physical injury and the other is a mental disorder, these disabilities may demonstrate similar symptoms, such as sleep disorder and loss of concentration. In these unique circumstances, the proper way to apply the anti-pyramiding rule is to assign a rating for both disabilities but only consider overlapping symptoms for one of the disabilities.
Complementary Disabilities vs. Secondary Service-Connected Disabilities
Secondary service-connected disabilities are rated using the same process as complementary disabilities. However, the service connection works slightly differently. For complementary conditions, the service connection arises from the same event occurring during the veteran’s service for all the conditions. An example would be chemical exposure that causes both fibromyalgia and lung disease.
For secondary service-connected disabilities, the service connection for the primary service-connected disability arises from the veteran’s service, while the secondary service-connected disability arises from the primary disability or treatment of the primary disability. An example would be chemical exposure that causes hypothyroidism and a heart condition that results from hypothyroid.
This article focuses on complementary conditions. For more information on establishing a secondary service connection, consult our article on service-connected VA disability.
Five Common Complementary Conditions That Add up to 100% VA Disability
Many complementary disabilities can be rated high enough separately to reach 100% disability when combined. For example, traumatic brain injury, post-traumatic stress disorder, partial blindness, partial deafness, chronic pain, and loss of function in a limb are injuries that can be rated high enough to produce an overall disability rating of 100%.
Furthermore, a crash or explosion from a combat or training incident can result in both physical and mental injuries. These injuries are complementary to each other because they commonly occur together and arise from the same events or set of actions.
1. Complementary TBI and PTSD Disabilities
Under the rating tables, the ratings of PTSD and TBI are high compared to other disabilities. This means that it would not be unreasonable to see a TBI rating going from 70% to 90% because of PTSD.
However, the only way to obtain a 100% overall disability rating with TBI and PTSD requires either a 100% rating for TBI or PTSD or a third disability rated at least 40%. This is because the highest rating for TBI and PTSD short of a total disability is 70%. And 70% (TBI) + 70% (PTSD) only reaches 90% overall disability. However, 70% + 100% reaches 100% overall disability. Likewise, 70% + 70% + 40% reaches 100% overall disability.
Thus, adding in a third disability, such as an arm or leg paralysis, rated 40% or higher can help reach 100% overall disability. In fact, even loss of range of motion in an arm or leg due to chronic pain or other physical injuries may be enough to get you to 100% overall disability without paralysis.
Watch this video in which one of our VA disability lawyers explains VA math and how 70% + 70% = 90%.
Will VA Rate TBI and PTSD Separately?
Yes, when the VA applies the anti-pyramiding rule properly. VA disability for PTSD and TBI is based on the overlapping symptoms but distinct causes of the disabilities. The VA TBI rating table uses three types of symptoms to rate the individual effects of TBI: physical, cognitive, and behavioral/emotional. The overall TBI VA rating depends on evaluations of the three symptoms.
PTSD is evaluated as a general mental disorder based on specific cognitive and emotional/behavioral symptoms. While there is some overlap, such as sleep disorders, difficulty concentrating, and memory loss, the VA TBI rating table has many more considerations, particularly physical effects, than the VA PTSD rating table. Thus, separate ratings can be assigned for TBI and PTSD by excluding overlapping symptoms before aggregating the ratings for an overall disability rating.
2. Complementary Disabilities in the Hand and Elbow
Another example of complementary disabilities arises when the hand or wrist becomes disabled due to circumstances that simultaneously cause an elbow disability. For example, repetitive stress can cause both nerve compression in the fingers, hand, and wrist along with tendonitis in the elbow. These are different injuries since VA disability for paralysis is rated as a nervous system injury while VA disability for tendonitis is rated as a musculoskeletal injury. Therefore, VA disability for carpal tunnel surgery can be obtained concurrently with VA compensation for elbow conditions. Likewise, a cubital tunnel syndrome disability rating and an elbow disability rating can both be assigned.
In this case, the rule against pyramiding may not even come into play. This is because the symptoms used to assign a VA rating for nerve damage in the hand due to paralysis of the median nerve or ulnar nerve do not overlap with symptoms used to assign a VA rating for loss of motion in the elbow.
To attain 100% overall disability, carpal tunnel (rated as paralysis of the median nerve) plus elbow tendinitis (rated as loss of motion in the elbow) would need a third disability rated at least 60%. This is because the maximum rating for carpal tunnel is 60% and the maximum rating for elbow tendinitis is 70%. Combined, they only get you to an overall disability rating of 90%.
To go from 90% to 100% you would need one more disability. For example, cubital tunnel – rated as paralysis of the ulnar nerve and has a maximum rating of 60%. So, carpal tunnel (60%) plus elbow tendinitis (70%) plus cubital tunnel (60%) would get you to a 100% disability rating.
3. Complementary Disabilities in Mobility
Disabilities in the legs, which can be separately assigned VA disability ratings, can be complementary. For example, for an injury to your hip that causes you to walk with a left-sided limp, VA disability may be available for that injury. If you also have osteoarthritis in your left knee, that would also cause you to walk with a limp on the left side. You will also be able to file a VA claim for osteoarthritis or obtain VA knee replacement compensation. This is because the disabilities are in different joints and, thus, even though one symptom overlaps, the disabilities are separately ratable based on the different symptoms, such as a loss of motion in the knee and hip.
For example, loss of motion of the hip can be rated as high as 90% and knee replacement can be rated as high as 60%. This combination adds up to a 100% overall disability rating.
If you can’t get to 100% that way, you might be able to if your other leg is affected in some way. The bilateral factor can boost your disability by 10%.
4. Veteran Disabilities Complementary to Chronic Pain
Chronic pain may be separately ratable depending on the source and location of the chronic pain. For example, VA disability for chronic pain caused by fibromyalgia would not preclude VA disability for runner’s knee. This is because widespread joint pain caused by fibromyalgia is a nervous disorder, and the symptoms used to rate fibromyalgia include stiffness but not necessarily loss of range of motion in the knee. The runner’s knee or chondromalacia patella VA disability rating, on the other hand, would be evaluated solely on loss of range of motion that would still exist even if the veteran’s fibromyalgia was controlled with medication.
This distinction would be even more obvious in a situation where fibromyalgia and PTSD occur together. One of the underlying causes of both fibromyalgia and PTSD is physical trauma. However, these conditions manifest differently – with fibromyalgia manifesting as body-wide pain and PTSD as physical, cognitive, behavioral, and emotional difficulties. This means that a fibromyalgia VA disability rating can be assigned separately from a PTSD VA disability rating, and the two can be aggregated using VA math to arrive at an overall VA disability rating.
In this example, the maximum rating for fibromyalgia is 40% and the maximum rating for PTSD is 70%. This combination gives an overall disability rating of 80%. To reach 100% overall disability, you need to have an additional disability rate at least 70%. As discussed above, TBI can be rated at 70%. Thus, combining TBI, PTSD, and fibromyalgia can get you to 100% overall disability.
5. Disabilities Complementary to Autoimmune Disorders
Autoimmune disorders like lupus, rheumatoid arthritis, and multiple sclerosis often accompany other disabilities, such as PTSD and fibromyalgia. These autoimmune disorders would be rated as non-overlapping symptoms following the anti-pyramiding rule.
Autoimmune disorders may also arise from environmental exposure to chemicals, pollutants, or even chemical weapon residues. These autoimmune disorders are rated separately from any physical injuries that you may have experienced during the same exposure event. For example, lung damage from inhaling pollutants would be complementary to and separately rated from lupus triggered by the same pollutants.
Estimate how much you’ll get with the VA Disability Calculator
Although it can be confusing, the VA disability calculator can help you find a combination for total disability. You should always include all the disabilities that you believe to be service-connected to your VA disability claim. For some veterans who have multiple disabilities but no single disability that can be rated as total, complementary disabilities may make the difference in going from 50% to 100% disability.
Need help finding the correct combination for total disability? Speak with a VA disability attorney at Woods & Woods for help with your VA disability ratings or to discuss filing or appealing a VA disability claim for complementary disabilities.
FREQUENTLY ASKED QUESTIONS
Anti-pyramiding is the process of the VA not giving you double the disability benefits for one injury. The trick is that sometimes one joint can have different kinds of injuries, which means fibromyalgia and carpal tunnel can both affect your hand, but you can get rated for both of them separately.
Whenever you are assessed, unless you have a permanent rating, your rating may be reduced. Talk to a VA disability attorney before you go to the VA so that we can better prepare you for your review. In our experience, we may have had other cases like yours before.
If you work with a VA disability lawyer like us, they should have doctors on staff to consult with and to look over your medical records. Not all doctors are familiar with the specific needs of disabled veterans. Make sure you work with one that does.