Understanding Pyramiding in VA Disability Claims
One common challenge veterans face when filing VA disability claims is something known as pyramiding. This concept can be confusing and frustrating—especially when you’re dealing with multiple symptoms or conditions that seem distinct but are evaluated as one under VA rules.
Let’s break it down clearly so you can navigate your claims more effectively.
What Is Pyramiding?
Pyramiding is defined under 38 CFR § 4.14, which states that the evaluation of the same disability under multiple diagnostic codes is to be avoided. Essentially, the VA doesn’t allow a veteran to be compensated multiple times for the same symptom or functional loss—even if multiple diagnoses exist.
For example, injuries to muscles, nerves, and joints of the same extremity often produce overlapping symptoms. Because of this, special rules exist within the rating criteria for evaluating those conditions.
In plain terms: you can’t receive multiple ratings for the same body part if the symptoms overlap. This is what the VA refers to as pyramiding.
How to Navigate Around Pyramiding
While learning about pyramiding can be discouraging, understanding how to work within the system helps you become smarter about your claims.
Here’s one real-world example: Let’s say a veteran has a 40% rating for a serious back condition—arthritis and degenerative disc disease (DDD). The problem? You can’t get another rating for the back if the symptoms are the same.
But here’s a better path forward: look for secondary conditions.
Common Secondary Claims to Consider:
- Depression or anxiety due to chronic pain or loss of function
- IBS or GERD as a side effect of medications
- Sleep apnea due to chronic pain and poor sleep
- Migraines, plantar fasciitis, or other orthopedic conditions linked to mobility changes
Each of these can be filed as a secondary condition. You’ll need:
- A current diagnosis
- Current symptoms
- A medical nexus linking the secondary condition to the primary one (e.g., back condition)
And yes—get this from a doctor. A note from an RN or PA can help, but a licensed physician’s opinion carries the most weight.
Example from Case Law: Esteban v. Brown
A helpful precedent is Esteban v. Brown, where a veteran had disfiguring scars, painful scars, and facial muscle damage—all from the same injury. Despite the clear variety of symptoms, the VA ultimately issued a single disability rating, because they stemmed from the same original condition.
Even when the symptoms are distinct, if they are connected to the same underlying disability, the VA may still restrict the claim to a single rating.
Mental Health Ratings and Pyramiding
Mental health conditions are another area where pyramiding applies. Veterans with PTSD, depression, anxiety, or panic disorder often feel like they deserve separate ratings for each. But the VA evaluates all mental health symptoms under a single rating—because these conditions tend to overlap.
So if you’ve got PTSD, and you also experience depression and anxiety, you’ll still only receive one mental health rating based on how severely all of those symptoms combined affect your daily life.
Final Advice: Avoid the Pyramiding Trap
The best strategy? Don’t try to stack ratings on the same body part or overlapping conditions. Instead:
- File for secondary conditions
- Focus on completely different body systems
- Get medical evidence from credible professionals
- Understand how symptoms must be distinct for multiple ratings to be valid
For example, instead of chasing an extra 10% for your back, look into a mental health claim worth 50%–70%, or a claim for migraines or foot pain worth 30%–50%. These approaches are often more successful and avoid pyramiding issues altogether.
Disclaimer
This article is intended for educational purposes only and is based on general interpretations of VA rules and court cases. It does not constitute legal or medical advice. For official regulations, visit 38 CFR § 4.14. For legal cases mentioned, see Esteban v. Brown. Always consult with an accredited VA claims agent, attorney, or healthcare provider for guidance specific to your case.
