Rachel Foster: Hello, I'm Rachel Foster. Welcome to CCK Live Under 5.
We are reviewing the rule against pyramiding with VA disability ratings. Pyramiding is the
VA term for reading the same disability or the same manifestations in symptoms twice.
The term comes from VA's regulations, section 4.14, regarding the avoidance of pyramiding.
This regulation explicitly prohibits the practice of pyramiding in VA disability claims.
When VA assigns a rating for service-connected disability, they use the rating schedule,
which lists specific diagnostic codes according to the disability, and each diagnostic code lists
the criteria symptoms that are required to get a certain level of compensation.
In some cases, a veteran might experience the same or overlapping symptoms as a result of two
separate conditions. Pyramiding becomes an issue in cases where veterans have multiple diagnoses
of particular types of conditions like, for example, mental health or respiratory conditions,
and it's an issue because those symptoms frequently overlap.
So, just a couple of things to note about the rating process in general,
it's that in VA's rating schedule, the rating levels under each diagnostic code are based on
the current symptoms a veteran is experiencing rather than just the veteran's diagnosis itself
or the prior severity in service. This means that the VA is looking to compensate veterans for the
current effects of their condition according to the diagnostic criteria, not just the diagnosis.
In doing this, VA is careful to avoid rating the same symptoms, even if it's for two different
disabilities, under separate diagnostic codes. In other words, VA does not want to compensate
the same symptom twice. Just as an example, say a veteran is service-connected for post-traumatic
stress disorder, or PTSD, due to an in-service combat event and experiences flashbacks,
hyper-vigilance, social isolation, and they also have severe sleep impairment and high
irritability around others. The PTSD rating criteria take these symptoms into account.
Later, it becomes clear for the same veteran that they also suffered a traumatic brain injury,
or TBI, while they were in service and service connection is awarded.
When it comes to rating the TBI, sleep impairment and irritability are also
core residual symptoms of the TBI and can be considered under its own diagnostic criteria
but here, there's clearly an overlap with the PTSD. If VA included sleep impairment and
irritability in its ratings for both PTSD and TBI, this would be pyramiding and under the regulations
prohibited. Since the veteran is diagnosed with both conditions, the symptoms of sleep impairment
and irritability could only be factored into the rating for one condition, not both. In
this example, VA might take into account the veteran's sleep impairment and irritability
when rating the TBI but not the PTSD or they could include them with PTSD but not the TBI.
Whatever they choose to do by law, VA must compensate the veteran for these symptoms and
apply those symptoms to the diagnostic code that would give the veteran the highest overall rating.
Thanks for watching this brief overview on pyramiding.
I hope you found this information helpful. Be sure to check out our
longer-form videos where we get more in depth on these topics or check out our blog.
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