Veterans may acquire disabilities of varying complexity and severity. In some cases, Veterans may acquire more than one illness, injury, or disabling condition. When they attempt to acquire disability compensation from the VA for all their symptoms, however, they run into an issue: VA pyramiding.
Today, let’s explain what pyramiding is, how it works, and how you can avoid pyramiding from affecting your total disability rating and maximum compensation.
Pyramiding involves attempting to receive more than one rating for the same symptoms or disability.
Imagine that a Veteran has PTSD and a traumatic brain injury. They file a VA disability claim for their PTSD on the grounds that it prevents them from sleeping. This results in negative health and life consequences.
However, they then try to submit a second claim for their traumatic brain injury, citing their inability to sleep or insomnia as a symptom once again. This is technically pyramiding, and federal law prohibits it. The Veteran is essentially trying to claim benefits for the same symptom twice.
Even though pyramiding is forbidden, some Veterans may require compensation for symptoms that are shared between multiple disabilities. That’s why it’s important to file your claim wisely with the assistance of educated Veterans law attorneys. Attorneys can ensure that you file your claim for the most severe conditions and symptoms to maximize your VA disability rating.
The VA bases all of its ratings on disability symptoms. That’s why many diagnosed disabilities or conditions have ratings of 0% if they are so minor that they don’t require medical attention, medication, or therapy.
Let’s take a look at PTSD once again as an example. If you are diagnosed with PTSD but have a rating of 0%, it means you don’t have any serious symptoms and don’t require medication. The VA never provides a rating for PTSD by itself; it looks at the severity of symptoms like nightmares or insomnia when deciding the rating the Veteran will receive.
Put another way, the VA rates disabilities based on how those disabilities affect Veterans’ lives and abilities to work. Impairments or separate conditions may lead to a higher rating or even TDIU if they lead to a Veteran’s disability at higher levels.
Notably, the VA does not evaluate identical symptoms from different disabilities when determining a Veteran’s overall disability rating.
For instance, if you have impaired memory from both a TBI and PTSD, the VA will only analyze how your impaired memory affects one of those conditions and its overall severity, not both.
The VA combines disability ratings from different disabilities or conditions. For example, if you have a 50% disability rating from PTSD and a 20% disability rating from back pain, you will have a disability rating of higher than 50% in all likelihood.
That said, the Department of Veterans Affairs doesn’t simply add up disability ratings together in an easy-to-understand formula or mathematical equation.
Instead, the VA uses a confusing, difficult-to-understand formula to determine total Veteran disability ratings. (Usually, the lower-rated disability is added to the higher-rated disability as a percentage, but there are exceptions).
That’s another reason why working with experienced Veterans law attorneys is wise: They can ensure the VA adds up your disability ratings properly and for maximum benefits compensation. Many lawyers also have disability calculators that you can use to estimate your disability percentage.
Again, the VA pyramiding rule means that you can’t use the same symptom from two different conditions to inflate your disability rating.
Even though the pyramiding rule exists, many Veterans have more than one disability that produces similar symptoms.
In that case, your best bet is to file separate claims for each disability but assign as many symptoms as possible to the higher-rated disability (or the disability that you believe will receive the highest rating from the VA).
Let’s return to the PTSD example one more time. Since PTSD is more likely to be rated higher than a TBI, unless the TBI is particularly severe or damaging, it makes more sense to assign most of your symptoms to your PTSD claim.
Then, you can file a separate claim for your TBI and assign any residual or TBI-exclusive symptoms to that claim.
In theory, this will help you maximize your disability compensation. Veterans law attorneys can help you make the right choices when filing your application.
Some conditions are more likely to be vulnerable to pyramiding than others. Some examples include:
Suppose you believe you have one or several of these conditions. In that case, you need to contact knowledgeable lawyers so they can help you draft the most effective disability claim possible and ensure you get the highest rating possible.
The key to avoiding VA pyramiding, or at least preventing it from negatively affecting your disability rating, is to connect your symptoms to your highest-rated conditions. For example, PTSD is typically rated at 70% for most Veterans, while traumatic brain injuries may be rated anywhere from 10% to 50% or higher.
Since it’s more likely that your PTSD will have a higher disability rating, it’s a smarter idea to connect as many symptoms to that PTSD as possible. These symptoms can include insomnia, mood swings, difficulty concentrating, etc. By connecting those symptoms to your highest-rated condition or disability, you ensure that your overall disability rating is as high as possible as well.
Furthermore, be prepared for the possibility that the VA may make a mistake. In some cases, the VA may misapply its own pyramiding rule.
For instance, a Veteran might file a disability claim for psoriasis and psoriatic arthritis. They might be denied benefits because of the pyramiding rule because the arthritis is caused by the underlying psoriasis condition.
That said, the VA says that both conditions should receive their own ratings, so an appeal should be successful.
Appealing a denied benefits claim on the grounds of pyramiding can be time-consuming and difficult, but not with the right attorneys on your side. Berry Law’s Veterans law attorneys can help you file a successful appeal to the VA and maximize your disability benefits from the get-go.
Here are some of the situations in which our lawyers can help if you are worried about the VA pyramiding rule affecting your benefits claim.
While you may receive service connection for multiple mental health conditions like post-traumatic stress disorder, depression, and anxiety, you cannot receive separate ratings for those conditions.
Instead, the VA will consider all symptoms together and issue one rating for your acquired psychiatric conditions. It can be difficult to determine which manifestations result from one mental disorder and which result from another.
Many conditions affecting the gastrointestinal system have similar restrictions. Although you may have separately diagnosed conditions like GERD and irritable bowel syndrome, you cannot receive separate ratings for those conditions. The totality of your symptoms will be considered together to establish a rating.
The rules against VA pyramiding can be found in the federal rules and regulations regarding diagnostic codes. The regulations will state which diagnostic codes in that section may not be given separate ratings because doing so would result in pyramiding.
In some cases where there isn’t a specific diagnostic code assigned to your condition, and it’s rated “analogously,” we may be able to argue for a separate rating under a code that would not be considered pyramiding.
VA pyramiding may or may not affect your disability benefits claim. But if you have multiple disabling conditions that share some symptoms, it’s important to contact knowledgeable Veterans law attorneys right away. The right legal firm can ensure that pyramiding doesn’t affect your disability rating and that you get as much compensation as possible.
Berry Law is the perfect law firm to contact if you are worried about pyramiding or you want to submit a new benefits claim ASAP. Our experienced lawyers can help you put together the most effective benefits claim possible and ensure that you file a claim for the most severe symptoms you experience. Contact us today for more information.
Sources:
VA Disability Compensation For PTSD | Veterans Affairs
Veterans’ Compensation for Service-Connected Disabilities | Benefits.gov
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