Trying to figure out what symptoms/conditions should be
rated for
military disability can be very complicated. In addition to the qualifications for each condition, there are also many
principles that change how the rules of
the VASRD are applied in different circumstance.
One of these wonderful little principles
is called “Pyramiding”. Trying to figure out exactly how this principle
works in different circumstances can definitely make me feel like this guy.
Let’s start my explanation with a parable,
of sorts. You are building a pyramid, and you have a single big block of stone
that is the same size as all the other stones. It needs to be added to the
pyramid. Now, you wouldn’t cut the stone in half and then put half of it on top
of the other before adding it; it would no longer be the right size. Plus, each
half of the stone is not a distinct and separate thing. They both make up the
same big stone. You can even give them two different names, but they are still
the same big stone. Similarly, you wouldn’t separate the symptoms of a single
condition, give them two different names and then say that they are indeed
distinct and separate. They are still the exact same condition. (Wow, this
parable is a bit rocky, no pun intended, and I completely lost the valuable
take-home message. Let’s see if I can do better.)
The basic rule of pyramiding is that you
cannot rate a single symptom more than once. There are many different
conditions that can cause the same symptoms. If you have two different
conditions that cause the exact same symptoms, then only one of them can be
rated. In cases like this, you’d pick the condition that gives you the higher
rating. For example, if you have tendonitis in your elbow that limits how much
you can move it, and you have a muscle condition that affects the muscles that
move the elbow and also causes limited motion in the same elbow, then only one
can be rated since they both cause the limited motion in the elbow. You don’t
get two ratings—one for the muscle and one for the tendonitis—just one rating.
Pick the condition that gives the highest rating.
Now the symptoms have the be the EXACT same
for this rule to apply. If you have two back conditions, one causes pain down
the arms, and the other causes pain down the legs, they can be rated separately
since the symptoms are NOT the same. They affect two totally different areas of
the body even though they are both back conditions. Make sense? Hope so, cause
it’s about to get worse.
When there are many symptoms involved, and
not all are shared, it gets a lot more complicated. Since you can’t rate the
same symptom twice, you have to separate the shared ones. The easiest way to
explain this is with an example. In this example, don't worry about the technical language: you don't need to understand what everything means to get the point of pyramiding.
There are two conditions:
An arteriovenous fistula is a condition
where a new passageway is created between an artery and a vein. It causes the
heart to work harder to get blood flowing. For this example, let’s say that it
causes the following symptoms: swelling in the arms and right ventricular
hypertrophy in the heart.
Chronic bronchitis is a condition where the
bronchi in the lungs swell and restrict how much air the lungs can take in.
Let’s say it causes an FEV-1 lung test measurement of 63%, a DLCO (SB) lung test measurement of 71%, and right ventricular
hypertrophy.
Here’s the list of symptoms:
Fistula: right ventricular hypertrophy, arm
swelling
Bronchitis: right ventricular hypertrophy,
FEV-1 63%, DLCO (SB) 71%
Both conditions have some of their own
unique symptoms, but they also share the most severe symptom: right ventricular
hypertrophy. The hypertrophy can only be used for one of the conditions,
whichever would benefit the most from it, meaning it would get a much higher
rating.
So let’s look at the ratings for both
conditions with their symptoms.
For the arteriovenous fistula, the condition with the
hypertrophy would rate 60%. Without the hypertrophy, it would rate 20%.
A 100% rating is clearly much better than
60%, so in this case, the bronchitis would be rated 100% with the hypertrophy.
The other condition can still be rated, but not with the hypertrophy, so it
would be rated 20%.
Pyramiding can get very complicated, but
take it step by step. Start by listing symptoms, and then see how the different
conditions are rated. If they have their own symptoms, they can be rated
separately.
Just remember: each symptom can only be
rated once.
