How Are Ratings for Veterans Disability Compensation Determined?

Instructions for assigning ratings for Compensation are found in Title 38 CFR Part 4. This chapter is also called the "VA Schedule for Rating Disabilities" or VASRD for short. Combined disability ratings are not additive but are determined through a formula process.

The Job of the Rating Activity

After all development actions are complete, the cross-functional team VSR refers the claim to the team RSVR (Rating Veterans Service Representative) for a rating. The RSVR reviews all the evidence associated with the claim, makes decisions on issues raised by the claimant, and identifies any inferred issues that should be addressed. The rater documents the rating decision in a standard format, using an automated rating preparation system called Rating Board Automation (RBA) 2000. The system automatically calculates the disability rating. After completing the rating decision, the team completes the claim for follow-up and issue. This process implements the rating decision by preparing either a monetary award or a denial. It also prepares notification letters for the claimant and representative.

When performing a rating evaluation, RVSRs consider all evidence associated with the claim. This includes service medical records, VA medical examination records, clinical summaries from VA medical centers where treatment has been provided to the veteran, and evidence provided from private sources, such as the veteran's treating physician.

The job of the Rating Veterans Service Representative consists primarily of interpreting medical records in deciding if the medical evidence is sufficient enough to result in a favorable or unfavorable decision. First, medical evidence must show the disabling condition that is ratable and that is ongoing and not acute. Second, medical evidence from service records or evidence of duty assignment or statements from others or corroborative history must show that an illness, aggravation or injury that could have resulted in the current condition was incurred in service. Finally, the medical evidence must tie it together such that there is a link established between the current condition of the claimant and the illness or injury or aggravation incurred in service.

Rating Decisions Are Not Made by Individuals with a Medical Background

It is interesting to note that RVSR's are not required to have a medical background, although some of them might be nurses or have served as medics in the service. Medical doctors are not prohibited from being raters, but the pay scale of GS 12 would likely not attract very many medical doctors. At one time, rating decisions were made by a so-called "rating board" that consisted of two non-medical rating experts along with a physician. In fact, an analog to veterans disability is Social Security disability where decisions regarding disability are made involving a doctor.

Rating boards were replaced in the early 1990s by several non-medical individuals making the decision or more recently by a single non-medical rater making a decision. This removal of medical personnel is due to a ruling by the Court of Appeals for Veterans Claims which has become famous, not only for its impact on not using in-house medical personnel, but also for its impact on the concept of new and material evidence in rating and appeal decisions.

Colvin v. Derwinski, 1 Vet. App. 171 (1991) CAVC Taken from The Veterans Advocate, January-June 2008

Colvin stands for a now deeply embedded and fundamental principle of veterans law – that VA may use only independent medical evidence to support its benefits decisions. The VA may not use the medical opinion or judgment of the VA rater or BVA Veterans Law Judge to support a decision.

For many years prior to Colvin, VA decisions were based on the findings of VA physicians who were part of the decision-making process. A doctor employed by VA would not only provide the medical opinion that would be used to decide the claim, he or she would participate in deciding whether to grant or deny benefits.

This practice of having VA doctors play a decision making role was ended by Colvin. The Court held that:

"If the medical evidence of record is insufficient, or, in the opinion of the BVA, of doubtful weight or credibility, the BVA is always free to supplement the record by seeking an advisory opinion, ordering a medical examination or citing recognized medical treatises in its decisions that clearly support its ultimate conclusions... This procedure ensures that all medical evidence contrary to the veteran's claim will be made known to him and be part of the record before this Court. Colvin, 1 Vet.App. at 175."

But advocates must watch out... even though the formal procedure of having a VA doctor play a decision making role stopped after Colvin, VA raters and BVA Veterans Law Judges persist in relying on their own medical judgments to decide claims. For example, the VA and BVA may often make a determination that an in-service injury was "acute, without chronic residual disability." However, the degree of injury and whether any disabilities resulted from the injury are medical assessments that the VA and the Board are not competent to make unless there is independent medical evidence to support that conclusion. This means that in many cases the VA's determination that an in-service injury was acute and did not result in chronic disability may violate Colvin.

Another common problem is that the VA may dismiss favorable medical evidence of record without citing to medical evidence in the record or medical literature to support its rejection.

A good rule of thumb based on Colvin is that if there is a VA-made medical conclusion – not directly based on a medical examination report, advisory opinion, or medical literature – the conclusion may be erroneous because the VA has no independent medical support for its findings. Decisions containing unsupported medical conclusions should be appealed.


The Rating Decision May Lead to Granting a Benefit Which Was Not Applied for

When submitting a claim for disability benefits, the Regional Office does not require the claimant to articulate every benefit that he or she is seeking. The claimant probably has no idea of what is available based on his or her evidence. The Regional Office is required to examine every claim including all of the evidence and testimony and determine if other benefits are applicable. For example a claim for Disability Compensation might end up being awarded for SMC or 100% for unemployability or providing aid and attendance or housebound allowances or providing retroactive benefits or housing allowances or clothing allowances or automobile adaptations and the list goes on and on. You should not be surprised if the award is different from what you expected.

Calculating Disability Ratings

If a claim is approved, VA will assign a disability rating from 0% to 100%. A 0% disability rating does not pay any benefit. Why then would one want such a rating? The answer is that by receiving a 0% rating, your Regional Office Veterans Service Center has recognized that the disability is service-connected. You have already overcome a large hurdle towards getting a benefit. If, in the future, the disability worsens or causes a secondary disability, then service connection is already established and you now only have to provide evidence that the condition has worsened or that it has caused a secondary condition. We post the rates for 2019 below. You will notice that the difference between 90% and 100% is significant. This represents the loss of earnings capacity between someone who might possibly still be employed and someone who at 100% is considered unemployable.

Disability Compensation Rate Table for 2019 (In Dollars)

Disability Percent

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Veteran Alone

140.05

276.84

428.83

617.73

879.36

1,113.86

1,403.71

1,631.69

1,833.62

3,057.13

Veteran & Spouse

479.83

685.73

964.36

1,215.86

1,522.71

1,767.69

1,986.62

3,227.58

Vet – Sp – 1 Child

 

 

516.83

735.73

1,026.36

1,290.86

1,609.71

1,867.69

2,098.62

3,352.41

Vet  – 1 Child

 

 

462.83

662.73

935.36

1,181.86

1,482.71

1,722.69

1,935.62

3,171.12

Additional Child

 

 

25.00

33.00

42.00

50.00

59.00

67.00

76.00

84.69

Addt. Schoolchild

 

 

82.00

109.00

136.00

164.00

191.00

218.00

246.00

273.58

A&A for Spouse

 

 

47.00

62.00

78.00

94.00

109.00

125.00

141.00

156.32

If veteran has a spouse who requires A&A, add "A&A for spouse" to the amount of dependency & rate code above.

Disability ratings are assigned in 10% increments from 0% through 100%. Each of these increments pays out a certain monthly benefit which also includes extra amounts for spouses and dependent children. 38 CFR part 4 – the Schedule for Rating Disabilities – contains all of the instructions and rating schedules for over 700 different bodily diseases, disorders or disabilities. Each of these is assigned a 4 digit disability code called a DC. For example there are 2 codes for tremor either 8105 or 8103. Tables in 38 CFR part 4 determine the rating levels for various degrees of disability under a disability code. For example PTSD is considered a mental disorder and has 6 different assignable ratings depending on the severity of the condition. They are 0%, 10%, 30%, 50%, 70% and 100%.

A veteran who is rated for multiple conditions can have anywhere from 1 to 10 or more different individual ratings for different conditions. Ratings are not additive and so the highest rating any claimant can have is 100%. VA uses a formula to combine these multiple ratings into a single rating called appropriately enough – a combined rating. They used to do it by hand, but in recent years they are entering various parameters from disability benefits questionnaires into a computer program that spits out the combined rating.

We will now take you through an example. The veteran has a rating of 30% for PTSD, a rating of 10% for hearing loss with tinnitus and a rating of 20% for back injury. Our first step is to order the ratings from highest to lowest – 30%, 20%, 10%

Our next step is to calculate the remaining efficiency for gainful employment. This is done by subtracting the first rating of 30% from 100% which leaves a 70% efficiency for gainful employment. This 70% remaining efficiency has a disability factor of 20%. We multiply 70% times 20% and get 14%. Now we add the original 30% to the 14% and we have 44% for a partial combined rating. But the veteran still has some remaining disability. So we go through the whole process again by subtracting 44% from 100% to determine the next remaining efficiency for gainful employment which is 56%. For this factor, the veteran has a 10% disability and therefore we multiply 56% by 10% and get 5.6%. Now we add this new rating to the 44% partially combined rating from the above calculations and this veteran now has a combined rating of 49.6%. The rules require rounding up or down to the nearest 10%. So this veteran's combined rating is 50%. Not 60% that would be obtained by adding all of the disabilities together.

VA does not calculate rates by hand, but instead uses a computer program that feeds off of the results of Disability Benefits Questionnaires to determine Disability Codes , determine individual ratings and calculate the combined rating based on the hand method above.

Outlining the Steps Above

  1. Veteran has a rating of 30% for PTSD, a rating of 10% for hearing loss with tinnitus and a rating of 20% for back injury. First step is to order ratings from highest to lowest – 30%, 20%, 10%
  2. Next step – Calculate remaining efficiency for gainful employment. 100% - 30% = 70% x .20 = 14% + 30% = 44%
  3. Next step – Calculate again remaining efficiency for gainful employment. 100% - 44% = 56% x .10 = 5.6% + 44% = 49.6%
  4. Round up or down to the nearest 10% resulting in a combined rating of 50%. The combined rating is not additive for individual ratings and so is not 60% as one would surmise.

Protected Ratings

Protection of a Scheduled Disability Rating

Preservation of disability evaluations – the protection of certain long-standing evaluations from reduction – derives from 38 U.S.C. 110 and is implemented in 38 CFR 3.951(b). The regulation provides that a Disability Compensation evaluation of any level that has been continuously in effect for 20 years or more will not be reduced to a lower evaluation except upon a showing that the higher evaluation was based upon fraud.

Example:

A Veteran files a claim for increase in his service-connected (SC) sinusitis, evaluated at 30 percent for over 20 years. The Department Of Veterans Affairs (VA) exam on which the 30-percent evaluation was based showed that the Veteran did not have incapacitating episodes, but did suffer three non-incapacitating episodes per year. This warranted only a 10-percent evaluation but the VA exam was misread by the Rating Veterans Service Representative (RVSR) as involving three incapacitating episodes. The current VA exam still shows symptomatology warranting a 10-percent evaluation. However, the 30 percent cannot be reduced because it is protected.

PL 102-86 states that a rating evaluation cannot be reduced solely because of a change to the rating schedule subsequent to August 13, 1991. 38 CFR 3.951(a) provides that a readjustment to the Schedule for Rating Disabilities shall not be grounds for reduction of a disability rating in effect on the date of the readjustment unless medical evidence establishes that the disability to be evaluated has actually improved. If the disability rating system changes the percentage of current single or combined rating of the veteran to a lower rating because of a change in the law, and the 20 years has not been achieved, the lower rating will apply.

The rating protection for a disability rating applies even if the veteran has elected not to receive a monetary award, due to offsetting from military retirement. This rating protection also applies to combined ratings and the individual ratings that make up that combined rating.

A protected disability rating is important, because for some awards, the computer system has been flagged to order general examinations in the future to reevaluate that particular disability. VA has the right at any time before the 20 year guarantee kicks in, to reduce a disability rating based on a reevaluation. Sometimes a reevaluation comes into play when a veteran on claim makes a request for a reevaluation for an increase in rating. There is a distinct possibility that a reevaluation could actually result in a reduction of the rating and not in an increase. Veterans on claim should be very careful about requesting reevaluations unless they are absolutely sure that their condition has gotten worse instead of better. This would also apply to applications for secondary disability, where the primary service-connected disability will also be reevaluated medically.

Protection of a Rating for Service Connection

If service connection for disability or cause of death has been in effect 10 or more years, the rating for service connection is guaranteed except for the following: Service connection can be removed if the original grant was based on fraud, or it is clearly shown that the person concerned did not have the requisite service or character of discharge. Protection against removing service connection does not only require continuation of service-connected status after 10 years. VA must also continue to pay Compensation at the appropriate evaluation for the protected condition as if service connection was not erroneous. However, the disability benefit amount will not be paid due to willful misconduct or alcohol or drug abuse.

Service connection for a disability is not severed simply because the bodily siting of a disability, or disability code associated with it, is corrected to more accurately describe the correct disability. For example disability evaluation for degenerative arthritis under 38 CFR 4.71a, Disability Code 5003 that has been in place for over 10 years can be recharacterized as traumatic arthritis under 38 CFR 4.71a, Disability Code 5010, but the service connection for the original disability is maintained.

So exactly what does this mean? If for some reason VA decides to reevaluate a claim and finds out that due to not meeting the level of entitlement for service connection for some reason due to misinterpretation of the evidence or lack of corroborating evidence, if this new development occurs before the end of 10 years from the effective date of the claim, the veteran will lose all benefits due under a service connection rating. In essence, this is sort of a statute of limitations that protects the veteran from losing everything if VA does not challenge the award of service connection prior to 10 years.


Please refer to the table of contents in the top right column of this page for more topics on VA Disability Compensation.