What injuries qualify for a total and permanent VA Disability Rating?

Almost any type of injury resulting in a service-connected disability can qualify for a 100% “Permanent and Total” (or “P&T”) VA disability rating. It is not an “injury” that triggers a VA disability rating of any level, but rather a current “disability” that was either caused by or made worse by your military service.

There are several ways of getting a 100% disability rating within the VA disability process, but it may not be considered permanent. Likewise, disabilities may be considered “permanent” without being “total” or 100%. Having the VA deem your disability “permanent and total” does unlock certain added benefits that either category alone does not provide. This article will help you sort out the concepts.

What is a VA Disability Rating and what does it mean?

VA disability ratings are percentage numbers, from 0-100%, that are a short-hand way of rating the general severity of a disability. Within the initial decision on a VA disability benefits claim, the VA assigns an individual VA disability rating to each disability claimed (for example, 30% for PTSD and 50% for hearing loss). The VA maintains criteria lists for various conditions listing the types of symptoms and sometimes the level of interference with your work and personal life that match each percentage level. The closest match will determine the individual VA disability rating.

The VA then also computes a combined, or overall, VA disability rating. This is not simple addition (using the example above, they don’t just add 30% + 50% and get an 80% overall rating).  In VA math, the above would amount to 65%, which would round to a combined 70% overall disability rating. You can use our calculator to add your ratings up here. This overall VA disability rating calculates your monthly benefit payment amounts. For higher ratings, if 30% or more, your marital and dependent children or parent status is also factored in for determining your monthly benefit amount.

A “total” disability rating means an overall VA disability rating of 100% (whether the 100% is reached for an individual disability or as combined with other disabilities), but that isn’t considered “permanent” unless the VA specifically finds it to be permanent.

A finding that a disability is “permanent” is only reached if it is reasonably certain, based on medical evidence, that the level of impairment (which may be less than 100%) will continue for life.

What injuries qualify for a permanent and total VA Disability Rating? 

There are numerous ways for a veteran to get a Total (100%) or Permanent (reasonably certain to continue for life) VA disability rating, but only a small number of veterans end up with a “Permanent and Total” VA Disability Rating.

There are only a few types of service-connected disabilities that are automatically assumed to be Permanent and Total: irreversible loss of use of both feet, both hands, one hand and one foot, loss of vision in both eyes, or being permanently bedridden. Other conditions, such as  cancer and post-traumatic stress disorder, may receive a 100 percent disability rating during a period of incapacity. However, these are not permanent because your condition could improve.

As to other claims, the process is more detailed. To get a Total (100%) VA disability rating for an individual disability, your medical records and other evidence will have to show that you suffer the symptoms that reach the 100% level criteria. For example, for PTSD, a 100% rating reflects total occupational and social impairment due to such symptoms as gross impairment in thought processes or communication, persistent delusions/hallucinations, grossly inappropriate behavior, disorientation to time or place, memory loss for names of close relatives, own occupation, or own name, persistent danger of hurting self or others, intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. For diseases and injuries of the spine, a 100% rating is given when the evidence shows “unfavorable ankylosis of the entire spine.” A Total (100%) VA disability rating can also be obtained as an overall rating, a combined number for more than one disability.

A Total (or 100% VA disability rating) is not considered Permanent unless that separate finding is made. The good news (in terms of your life) is that sometimes disabilities improve. The unfortunate result is that sometimes disability symptoms get worse over time. Because of that, the VA is unlikely to determine that your disability is permanent without some reasonable certainty of that prognosis. This is also the case with TDIU (Total Disability Individual Unemployability) cases; the underlying assumption is that you may improve and you may again be able to be employed, so it isn’t Permanent. However, if the VA grants TDIU, you will be considered P&T, so long as you do not go back to work and lose the TDIU. 

There is some increasing stability of expectation for your disability rating level if your condition and rating remain the same for a number of years or after a certain age. For example, under the Five Year Rule, the VA has reduced authority for re-examining or reducing VA disability ratings after they have been in place for five years. In simple terms, under the Five Year Rule if you have been rated at a current VA disability for five years, the VA will generally need to have two exams showing sustained improvement in order to reduce.

Under the 10-Year Rule, the VA cannot sever or change their service-connection finding for any disability after it has been in place for ten years. 

Under the 20-Year Rule, the VA cannot reduce an individual VA disability rating that has been in place continuously for twenty years. 

Under the 55-Year Rule, once a veteran has reached the age of 55, the VA will generally not set up a future examination and will consider the issue to be static, meaning permanent – unless there is evidence to show that the condition would improve. 

Of course, none of these apply if the VA discovers that the disability claim was fraudulent.

What is the benefit of getting a Permanent and Total VA Disability Rating?

Is there any reason you would want to have a “Permanent and Total” VA disability rating? On a personal level, of course not, but in terms of predictability and level of your VA benefits, yes. There are certain benefits that attach when your VA disability is deemed “permanent and total.” These benefits include CHAMPVA (VA healthcare for your dependents), Chapter 35 Dependents Educational Assistance Program (money for your kids for school), Dependency and Indemnity Compensation (DIC) (death benefits), and certain other benefits on the state level.

Are you trying to determine if your VA disability has been considered Permanent and Total? Just ask the VA. You can access this through your eBenefits account or make a request to your nearest VA office location.

Why did my injury not qualify for a permanent VA Disability Rating? 

As a reminder, “injuries” do not trigger VA disability benefits, but instead it is your current condition (“disability”) that is connected to your military service that can trigger entitlement to VA disability benefits.

There is only a small category of disabilities presumed to be Permanent and Total (P&T) on their face. Those are irreversible loss of use of both feet, both hands, one hand and one foot, loss of vision in both eyes, or being permanently bedridden. If your disability is something else, then the VA assumes it may not be permanent unless there is compelling evidence to the contrary.

The standard for a VA finding that your disability is “permanent” is that it is reasonably certain, based on medical evidence, that the level of impairment will continue for the rest of your life. It is a high standard, and your medical records usually will not reflect that, at least not within the first few years of your underlying injuries and continuing disability. The reality is that you might improve (which is good), but you also might get worse (not so good).

If you have received your initial disability claim decision and it did not contain a finding that your disability is Permanent, you neither fell within the small category of presumptive P&T cases nor presented medical evidence that it was reasonably certain your level of impairment would continue for life.

If you did not receive a Permanent finding but believe you met the criteria for it, you can file a VA disability appeal asking for that decision to be changed. This VA claim appeals process can be used for other errors you believe the VA made.

Can I get a permanent VA Disability Rating in the future? 

Yes, it is possible to get an increased VA disability rating, including a finding that a disability is permanent. Although a 100% combined (or overall) VA Disability Rating (a schedular rating) is not considered “Permanent and Total” you can request that added finding by letter to the VA accompanied by medical evidence showing that your condition is reasonably certain to continue at the same level for the rest of your life. 

You also may get a permanent VA disability rating through an appeal of your initial claims decision (which can be done within one year of that decision). 

Can my VA Disability Rating change without an appeal? 

Yes. Even after an initial decision is made on a VA disability benefits claim, the VA continues to have the right to request a re-evaluation of your condition with the new C&P examination within certain timeframes and restrictions. You, the veteran, can also request a re-evaluation of your condition after the one-year window for an appeal if you have evidence showing that your condition has deteriorated since the original decision was made.

How to appeal my VA Disability Rating? 

A VA disability rating dispute usually plays out as an appeal of the initial decision. There are three types of appeal (or decision reviews) of your initial VA disability claim decision:  Higher Level Review, Supplemental Claim, or Board Review. The type of claim appropriate for you depends on the specific details of your case, what the VA decided, and what you want to achieve. 

For example, if evidence was missing from your file, you may wish to file a Supplemental Claim. If the VA overlooked evidence that was already in your claims file, you might just want a Higher Level Review to have a more experienced VA examiner review the file with your explanation of what was missed. A Board Review with a live (virtual or in-person) hearing might be the best choice if you want a more personal touch. If you disagree with the outcome of the first option you choose, there are opportunities for further review after that. 

At the appeal level, you should consider hiring an experienced VA disability claims attorney. This is your first case with the VA, but they have handled similar cases hundreds, if not thousands, of times with other veterans. They can provide insight and direction based on their extensive training and experience, and most work on a contingency basis which means they don’t get paid until you get paid. VA statistical reports show that veterans represented by a private va disability attorney get the highest percentage of good outcomes on appeal.


Veterans Law Group is made up of VA disability claim attorneys that have been helping veterans like you for over two decades and have recovered millions of dollars in disability benefits for veterans. If you are considering an appeal of your VA disability decision, Veterans Law Group will give you a free case evaluation. Ready to get started?

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