Apr 12

The Rule Against “Pyramiding”

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A huge source of confusion among Veterans is how individual disability ratings are combined to produce their overall rating. When a Veteran has two or more service-connected disabilities, their overall disability percentage is determined by using a special table to combine the individual ratings, NOT by adding them together using simple addition. To do this, the VA calculates the total percentage by considering each disability in order of severity, beginning with the highest evaluation. These detailed calculation instructions are found here.

Here is an example: A Veteran is rated 30% for one service connected condition and 20% for another. Rather than adding these two numbers together, to get 50%, you use the combined rating table.

VA disabilities, including ones from a single disease or injury, must be rated separately. Then, all ratings are combined according to 38 C.F.R. § 4.25. There is one exception to this rule known as anti-pyramiding. This is basically a prohibition against compensating a Veteran more than once for the same disability or the same symptoms.

For example, in the CAVC case, Esteban v. Brown, the court had to determine the issue of whether the Veteran suffered from only one disability, which would result in a single rating, or, whether the Veteran suffered from multiple disabilities, resulting in separate ratings for each separate disability. The Veteran in this case suffered from three conditions as a result of a car accident during service: disfiguring scars, painful scars, and facial muscle damage that interfered with chewing. While the VA admitted that the Veteran could be rated as 10% disabled under any of the 3 codes, it did not issue separate disability ratings. Fortunately, in the end, the court determined that because the codes at issue addressed three different disabling conditions (cosmetic damage, pain, and limitation of function), the Veteran should get separate awards.

Additionally, in Amberman v. Shinseki, a Veteran suffered from two service-connected mental disorders: bipolar affective disorder and PTSD, which were rated together. The Veteran argued that the two service-connected disorders were not the “same disability” and should be rated separately. The court recognized that bipolar affective disorder and PTSD could have different symptoms, and therefore the VA, in some situations, has to treat these as separate disabilities. It is important to note that in this case bipolar affective disorder and PTSD shared no similar symptoms. This may often be challengting to argue however since often mental impairments have many overlapping symptoms.

If a Veteran wants to receive separate ratings as a result of a single disease or injury, they should:
1. Make an argument that they suffer from more than one disability – shown by a variety of symptoms, and
2. the diagnostic codes are not duplicative and do not involve overlapping symptoms

If a Veteran successfully argues these points, he or she would be entitled to separate ratings.