The VA’s Avoidance of Pyramiding Rule

Whether you just started applying for VA benefits or had a claim rejected, it’s essential to understand the pyramiding rule. It’s the VA’s method of avoiding paying twice for the same symptoms. And, if the VA thinks your claim looks like pyramiding, even if that wasn’t your intention, it could affect your VA rating. This post explains VA disability pyramiding and why you may want help with your claim.

What is pyramiding?

Pyramiding is the VA’s term for trying to receive more than one rating for the same disability or symptoms, and federal law prohibits it.

If you have multiple disabilities and are trying to file claims for them, you must understand the pyramiding rule. It means a symptom can’t be rated more than once, even if two different disabilities cause it. 

So, if two separate conditions cause the same symptom, you want to make a case to connect the symptom to the highest-rated condition. That way, you get the most disability compensation for the symptom.

The VA bases ratings on symptoms

To understand pyramiding, you need to know that VA bases ratings on symptoms and how severely your condition affects your health and life. So while you may receive a diagnosis of post-traumatic stress disorder (PTSD), for example, the VA doesn’t provide the rating for PTSD. Instead, it looks at the severity of your nightmares and inability to sleep. 

In other words, the ratings are about how your disability affects your life, not the disability itself. 

The VA uses diagnostic codes to rate symptoms or “residuals.” You can’t attempt to claim the same symptom under more than one diagnostic code. Using the mental health example again, let’s say you developed PTSD after a traumatic brain injury. Both disabilities can cause impaired memory, but the VA can’t use this symptom in its evaluation of both. Instead, the VA would determine whether impaired memory gets a higher rating as a PTSD or TBI symptom.

VA combined ratings

VA combined ratings are the way the VA rates multiple disorders or symptoms to determine the compensation and benefits you receive. The combined rating can’t be more than 100% because a person can’t be more than totally disabled. 

When the VA assigns you a disability rating, it is presented as a percentage. The percentage signifies how much the disability reduces your ability to function or how it impacts your overall health. This approach is called the “whole person theory.” The VA uses it to reduce the likelihood that a veteran’s rating adds up to more than 100%, which isn’t allowed because a person can’t have more than total disability.

But the VA doesn’t simply add up your assigned disability percentages. It uses a formula to determine your rating. And VA math is confusing and difficult to understand. But if you have multiple disability ratings, you must understand how to get the highest rating possible. This post explains more about doing VA math with the combined ratings table and provides examples.

This disability calculator can help you estimate your disability percentage. The calculator gives you an idea of the rating you’ll receive from the VA once you file a disability claim. But remember that the calculator is an estimate based on what you enter, not a guarantee.

Are VA pyramiding and rating stacking the same?

People use the terms “pyramiding” and “rate stacking” interchangeably when discussing the VA’s anti-pyramiding law. While you can receive a combined rating for various symptoms under more than one disability, you can’t “stack” each disability with the same symptoms. 

You may be tempted to list all the symptoms for each disability because they are real and impact your well-being. Also, you feel they are tied to more than one disability. But in that case, the VA may decide to award you a single rating for the symptom with the highest rating rather than award you multiple ratings.

Common overlapping conditions

Many of the conditions veterans have due to service-related illnesses and injuries have similar, overlapping symptoms. This makes it easier to accidentally file claims the VA would consider to be pyramiding. Below are some examples.

Chronic fatigue syndrome and fibromyalgia

Fibromyalgia causes widespread pain, memory issues, sleep disturbances or insomnia, mood disorders, and extreme fatigue.

Doctors often misdiagnose chronic fatigue syndrome (CFS) and fibromyalgia because they have similar symptoms. CFS symptoms include muscle and joint pain, extreme fatigue, inability to concentrate, sleep disorders, anxiety, depression, and weakness.

Depression and apnea

Depression and sleep apnea can go hand-in-hand. People with depression are more likely to have sleep disorders than those without. Also, an inability to sleep can result in the onset of depression. 

Depression symptoms include overwhelming sadness, sleep changes, appetite disturbances, and an inability to concentrate.

Sleep apnea symptoms include excessive sleepiness, sleep changes, and an inability to concentrate.

Knee injuries

Knee injuries, and musculoskeletal injuries in general, are some of the most common disabilities veterans experience. Ongoing knee pain can be related to a knee injury, another type of leg injury, arthritis, or another injury altogether. Determining the cause of the knee pain and how to claim the symptom may be challenging.

Persian Gulf Sand Lung and COPD

Persian Gulf Sand Lung and chronic obstructive pulmonary disease (COPD) are two other conditions with similar symptoms.

Persian Gulf Sand Lung is caused by inhaling minute particles, which get trapped in the lungs. Particulate matter levels are higher in areas like the Persian Gulf because of dust storms, industrial emissions, construction, and vehicle exhaust.

Persian Gulf Sand Lung symptoms include cough, shortness of breath, and sputum.

COPD symptoms include shortness of breath, chest tightness, chronic cough, sputum, wheezing, and frequent chest infections.

PTSD and TBI

Many veterans have post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Both have their own symptoms, but they also have some overlapping characteristics.

PTSD symptoms include flashbacks, nightmares, emotional numbness, difficulty sleeping, lowered ability to concentrate, feeling anxious or jumpy, and anger.

TBI symptoms include loss of consciousness, feeling confused or disoriented, headache, fatigue, difficulty sleeping, loss of balance, blurred vision, difficulty concentrating, memory issues, mood changes, depression, and anxiety.

In some cases, veterans experience PTSD resulting from a traumatic brain injury. If the VA finds the two conditions indistinguishable, the veteran will receive one rating. But, if the symptoms are distinct and separate, the veteran can receive a rating for both TBI and PTSD.

Syphilis and MS

Two distinct conditions that exhibit similar symptoms are syphilis and multiple sclerosis (MS). Syphilis mimics MS, particularly in the advanced stages (neurosyphilis).

Syphilis symptoms include cognitive changes, motor dysfunction, vision problems, and sensory dysfunction.

MS symptoms include back pain, blurred or double vision, tremors, muscle cramps, sensory dysfunction, fatigue, and poor balance.

While the two disorders have overlapping symptoms, they have much different ratings.

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How to avoid VA pyramiding and stacking VA benefits

Avoiding pyramiding can be complicated, but it’s necessary. If the VA sees that you have stacked your symptoms in a claim, it could take longer to process your claim. The result may be that you receive a single rating rather than multiple ratings you were expecting.

When filing a VA disability claim, remember that the symptoms must be the same for the anti-pyramiding rule to apply. You can’t receive multiple ratings for the same symptom. If you have a condition that causes leg pain and one that causes arm pain, you can be rated for both symptoms because they are different. But if you have two conditions that cause the same symptom – lower back pain and stiffness, for example. Lower back pain can only count once toward your VA disability rating. So, veterans should avoid filing claims for multiple conditions with identical symptoms.

Sometimes, however, the VA misapplies the pyramiding rule. For example, a veteran who files VA disability claims for both psoriasis and psoriatic arthritis may be denied on the grounds of pyramiding, since one is caused by the other. However, the VA’s Schedule for Rating Disabilities clearly states that the two conditions should each receive their own ratings.

If the VA refuses to properly rate your claim because of pyramiding, you can appeal that decision. To help your appeal, you may want to talk to a medical professional who can help show that the disability is a distinct condition that merits an additional rating. Also, consider discussing your claim and medical findings with a legal professional who can assist you in the appeals process.

Woods and Woods can help

If you are concerned about pyramiding or if your claim was wrongly denied based on the rule, you need help. The law is confusing, but you deserve to be compensated for your service-related medical issues. Contact Woods and Woods to file an initial claim or appeal a rating decision. You only pay us if we win your appeal. 

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