Avoidance of Pyramiding: How to Avoid Stacking Your Disability Benefits

What should you do if you have a symptom that is caused by multiple conditions, both of which you developed because of your active duty service? Do you claim that twice on your VA disability claim?

The VA has a term for this: pyramiding. Their rule regarding pyramiding is simple – do not do it.

However, it is not always someone trying to get away with double dipping their benefits. Sometimes, it happens unintentionally.

Today, you will learn about pyramiding, how to apply for VA disability the right way, and how to ensure you are getting the compensation you deserve.

How Is VA Disability Calculated?

Benefits are assigned based on your disability rating, a number that is calculated based on how severely your condition affects your health and your life. If you have multiple ratings from multiple conditions, the VA combines the ratings together with VA math and you receive one VA disability rating.

Unfortunately, it is not as straightforward as simply adding all the ratings together.

Your rating is based on the severity of your condition or disability. When assigned a disability rating by the VA, it shows up as a percentage. The percentage signifies how much the disability reduces your ability to function or how it impacts your health overall. The approach is called the “whole person theory,” and the VA uses it to reduce the likelihood that a veteran’s rating adds up to more than 100% since that percentage equates to being fully able-bodied.

To estimate your disability percentage calculation, the VA will use the VA disability calculator. This calculator gives veterans an idea of what rating they will get from the VA once they file a disability claim. 

Why Stacking Happens – It is Not Always Intentional

Since the VA calculates your disability rating based on the symptoms you live with and how they impact your life and health, you need to factor in the condition as well as the symptoms.

Unfortunately, confusion can result because so many conditions have similar symptoms. Some health conditions and diseases end up misdiagnosed because the patient’s symptoms are so similar to other diseases.

Additionally, each person is unique. Just because two people have the same disease does not mean their symptoms will line up perfectly. The VA has a set of symptoms for each diagnosis in the VA Rating Schedule, but a veteran’s symptoms might not always align with the ones on that guide.

Since some symptoms can overlap, determining the correct percentage can be difficult – not just for the veteran but for the VA as well. Sometimes, even those in charge of calculating benefits mistakenly conclude that granting an additional rating for a symptom would be considered pyramiding. In some cases, it is, but in others, having a separate rating is necessary for the veteran to get their due compensation.

Here one of our VA disability lawyers goes over the questions Woods and Woods, The Veteran’s Firm, is often asked about veterans’ disability claims and appeals.

Symptoms vs. Conditions – Why the VA Rates This Way

The VA disability rating system might not make sense at first. After all, other systems – like private insurance companies – base coverage on diseases/conditions themselves, not the symptoms a patient is experiencing.

The VA bases their calculations on the idea that a veteran is 100% able-bodied before their enlistment or draft. After active duty, the VA determines the amount of compensation a veteran gets on how far from able-bodied they have become.

Unfortunately, some veterans are totally disabled after their service, whether from an injury, illness, or exposure to a toxin like Agent Orange. When this happens, they receive 100% disability coverage from the VA.

Other veterans’ conditions affect their lives to varying degrees. The VA disability calculator will help them determine how far removed from 100% able-bodied they are due to their condition.

Here is a video explaining how the VA combined ratings table works from one of our Veterans Disability Lawyers.

Conditions with the Same or Similar Symptoms – What Then?

What does the VA do when a veteran presents with common overlapping conditions? They must try and distinguish between the disabilities and their manifestations to determine whether the symptoms do, in fact, overlap or if they are similar yet separate.

For example, an arteriovenous fistula is a condition in which the body creates a new passage between a vein and an artery. The heart must work harder to pump the blood, and the condition can cause right ventricular hypertrophy (hardening of the wall of that part of the heart).

Chronic bronchitis is another condition that can cause right ventricular hypertrophy.

Of course, each condition has its own set of symptoms, which the veteran can claim to get a higher rating. When it comes to the right ventricular hypertrophy, though, they can only claim that once.

Interestingly, almost every condition can have a different rating for similar symptoms. When filling out your application for disability compensation on the DoD/VA e-Benefits website, you will want to choose the manifestation that gets the highest VA disability rating.

Using the example above, if the condition (bronchitis vs. arteriovenous fistula) would earn you a higher rate than the other when including hypertrophy than without it, that is the condition you want to claim. So, if the hypertrophy raised the fistula rating to 60%, that is great. However, if the hypertrophy symptom elevated the chronic bronchitis rate to 100%, that is even better. Therefore, you would want to add the atrophy on your bronchitis claim.

10 Ways that the VA Rates Disabilities

Common Overlapping Conditions: PTSD and TBI Related/Combined and More

Many illnesses, diseases, and injuries can lead to similar symptoms. Just look at COVID-19 and the flu. Without a test, it can be impossible to distinguish which illness a patient has.

Similarly, many of the conditions that veterans face because of service-related illnesses and injuries have similar, overlapping symptoms. Here are some examples.

PTSD and TBI Related/Combined

Two conditions that many veterans have are post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Both have their own set of symptoms, but they also have some overlapping characteristics.

• PTSD: Flashbacks, nightmares, emotional numbness, difficulty sleeping, lowered ability to concentrate, feeling anxious or jumpy, irritation, anger
• TBI: Loss of consciousness, feeling confused or disoriented, headache, fatigue, difficulty sleeping, loss of balance, blurred vision, difficulty concentrating, memory issues, mood changes, depression, anxiety

According to the DoD, nearly 314,000 service members have received a TBI during their training or combat duty. In some cases, veterans can experience TBI-related PTSD. If the VA finds that the two conditions are indistinguishable, the veteran will receive one rating. However, if the symptoms are distinct and separate, the veteran can receive a rating for both TBI and PTSD.

Persian Gulf Sand Lung and COPD

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

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

Symptoms of these conditions include.

• Persian Gulf Sand Lung: Cough, shortness of breath, sputum
• COPD: Shortness of breath, chest tightness, chronic cough, sputum, wheezing, frequent chest infections

Chronic Fatigue Syndrome and Fibromyalgia

Fibromyalgia is a disorder that causes widespread pain, in addition to memory issues, sleep disturbances or insomnia, mood disorders, and extreme fatigue.

Chronic fatigue syndrome (CFS) and fibromyalgia are often misdiagnosed conditions because they have so many similar symptoms. The symptoms of CFS include muscle and joint pain, extreme fatigue, inability to concentrate, sleep disorders, anxiety, depression, and weakness.

Syphilis and MS

Finally, two very distinct conditions that exhibit similar symptoms are syphilis and multiple sclerosis (MS). In fact, syphilis is said to mimic MS, particularly in the advanced stages (neurosyphilis).

• Syphilis: Cognitive changes, motor dysfunction, vision problems, sensory dysfunction
• MS: Back pain, blurred vision or double vision, tremors, muscle cramps, sensory dysfunction, fatigue, poor balance, and much more

A behind the scenes look at who works for you at Woods and Woods, The Veteran’s Firm.

How the Law Defines Pyramiding

According to 38 CFR § 4.14, pyramiding is the “evaluation of the same disability under various diagnoses.” Disabilities caused by injuries to various parts of the body can overlap. Therefore, special rules apply for appropriate body systems during the evaluation process.

Legally, claiming physical manifestations of injuries in the following scenarios should be avoided (avoidance of pyramiding).

• Symptoms/conditions that are not service-related
• Claiming the same manifestations/symptoms under different diagnoses

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Avoidance of Pyramiding: How to Avoid Stacking Benefits

If the VA accuses you of pyramiding, it can slow the claims process down significantly or they might reject your claim altogether.

When filing a VA disability claim, remember that the symptoms must be the same for the anti-pyramiding rule to apply. You cannot claim the same symptom twice. If you have a condition that causes leg pain and one that causes arm pain, you can claim both symptoms because they are different. However, let us say you have two conditions that cause the same symptom – lower back pain and stiffness, for example. Lower back pain can only be counted once toward your VA disability rating.

Now, you will want to compare the two conditions. Each will have a different rating. Your goal is to choose the condition that provides you with the highest disability rating.

Common VA Disability Combinations That Get You to 100%

Disability Rating and Pyramiding – A Complex Issue

Avoidance of pyramiding can be complicated, but it is one you need to keep an eye on when you submit your VA disability claim.

To abide by their anti-pyramiding rule, the VA overapplies it in some cases, assuming similar symptoms automatically overlap.

However, you may be able to get separate ratings for each of your conditions, even those with similar symptoms. If the VA denies your claim, you can appeal that decision.

The best way to ensure your success with such an appeal is to:

• Talk to a medical professional to help show that the disability you sustained during active duty resulted in separate and distinct conditions without overlapping symptoms
• Discuss your claim and medical findings with a legal professional who can help you through the appeals process.

A behind the scenes look at who works for you at Woods and Woods, The Veteran’s Firm.

Choose a Legal Team to Help You Get the Compensation You Deserve

One of the best ways to ensure you are not improperly stacking your benefits is by hiring a legal team with experience in VA disability and avoidance of pyramiding.

Woods and Woods, The Veteran’s Firm has 35 years of experience helping thousands of veterans get the disability compensation they deserve. They work hard for each client fight VA-denied claims every day.

Their good reputation does not just stem from the plethora of happy clients. They have a good reputation because they refuse to cross moral, ethical, and legal lines. When you work with the Woods and Woods legal team, you do not have to worry about rejected claims or dropped benefits because of stacking.

The Woods and Woods team will help you estimate the benefits you are eligible for using their free VA disability calculator. Once you discover how much you are entitled to (based on VA disability percentages), they will help you through the process of getting compensation.