VA Rating Pyramiding Violations Explained: What They Are and How to Avoid Them

Pyramiding is one of the most common reasons VA claims get denied or ratings get reduced, yet many veterans have never heard of it. Understanding what pyramiding is and how to avoid it can make the difference between maximizing your combined rating and losing benefits you have already earned.

What Is Pyramiding?

Pyramiding occurs when the VA awards separate disability ratings for the same symptom or manifestation under different diagnostic codes. The term comes from "building a pyramid" by stacking multiple ratings for what is essentially the same underlying problem.

The rule is codified in 38 CFR 4.14, which states that the evaluation of the same disability under various diagnoses is to be avoided and that duplication of compensation will not be permitted for the same manifestation of a single condition.

The Principle Behind the Rule

If you have lower back pain with limited range of motion, you should not receive one rating for "back pain" and another for "limited range of motion." Both are manifestations of the same spinal condition. The VA rates the total functional impairment under one diagnostic code.

Common Pyramiding Examples

Back Conditions

Violation: Rated separately for "lumbosacral strain" at 20% AND "degenerative disc disease" at 10% when both affect the same area and cause the same symptoms.

Correct approach: One rating under the most appropriate diagnostic code (usually the higher-rated one) that accounts for total functional impairment from all back issues.

Mental Health Conditions

Violation: Separate ratings for PTSD at 70%, depression at 50%, and anxiety at 30% when all three stem from the same traumatic event and share overlapping symptoms.

Correct approach: One mental health rating under the primary diagnosis (usually PTSD). The VA uses the General Rating Formula for Mental Disorders, which is diagnosis-agnostic and rates based on overall occupational and social impairment.

Knee Conditions

Violation: Separate ratings for "limited flexion of knee" at 10% AND "knee pain" at 10% when both are manifestations of the same knee injury.

Correct approach: Single rating under the appropriate diagnostic code. Pain is already factored into the range-of-motion limitation.

Sleep Apnea and Fatigue

Violation: Rated for obstructive sleep apnea at 50% AND chronic fatigue syndrome at 40% when the fatigue is a direct symptom of the sleep apnea.

Correct approach: Rate only the sleep apnea. Its rating already accounts for effects including fatigue.

What Is NOT Pyramiding: Valid Separate Ratings

Understanding what counts as pyramiding requires knowing what does not count. These are all valid separate ratings:

Different Body Parts

You can receive separate ratings for:

• Left knee AND right knee: Each rated independently
• Cervical spine AND lumbar spine: Different sections of the spine
• Right shoulder AND left shoulder: Separate joints

Secondary Conditions with Distinct Symptoms

Valid example:

• Primary: Knee injury at 20% (causing knee pain and limited flexion)
• Secondary: Back problems at 10% (caused by altered gait, producing back pain and limited spinal range of motion)

This is NOT pyramiding because the back condition produces distinctly different symptoms in a different body area, even though the knee injury caused it.

Invalid example (pyramiding):

• Primary: Knee injury at 20%
• Claimed secondary: "difficulty walking" due to knee injury

Difficulty walking is already accounted for in the knee rating. It is not a separate condition with new symptoms.

Nerve Injury AND the Body Part It Supplies

38 CFR 4.14 specifically allows separate ratings for:

• The nerve itself (e.g., sciatic nerve damage at 40%)
• The body part supplied by that nerve (e.g., foot drop from sciatic nerve damage)

This exception is written directly into the regulation.

Different Body Systems

Separate ratings for conditions affecting different organ systems:

• Respiratory condition (asthma) AND digestive condition (IBS)
• Cardiovascular condition (hypertension) AND endocrine condition (diabetes)
• Musculoskeletal condition (back injury) AND neurological condition (TBI)

How the VA Identifies Pyramiding

The VA catches pyramiding through several mechanisms:

• During initial rating: Senior raters and attorneys review decisions for duplication before they are finalized
• During reexaminations: C&P examiners may note overlapping symptoms, triggering a review
• During appeals or increase claims: VA attorneys thoroughly review your entire file
• Through quality reviews: Random audits specifically look for pyramiding errors

Consequences of Pyramiding

Immediate Denial

If the VA identifies pyramiding when you file a claim, they deny the duplicative claim and rate only under one diagnostic code.

Future Rating Reductions

If pyramiding is discovered after you have already been receiving both ratings:

• You receive a proposal letter explaining the violation
• You have 60 days to submit evidence or argument
• You continue receiving the higher payment during the 60-day period and any appeal
• If you do not successfully challenge the finding, the duplicate rating is removed

Overpayment

If the VA reduces your rating due to pyramiding, they may claim overpayment. However, the VA generally cannot recoup overpayments resulting from their own errors. Argue that any overpayment resulted from VA error, not fraud, and request a waiver if they attempt collection.

How to Avoid Pyramiding Violations

1. Clearly Distinguish Symptoms in Every Claim

When filing for multiple conditions, explicitly state what symptoms each condition causes and how they are different. Be specific about different body areas and functional limitations.

2. Use Secondary Service Connection Properly

Emphasize that the secondary condition causes new symptoms in a different area, not just a worsening of existing symptoms.

Good claim: "My service-connected left knee injury has caused me to alter my gait, resulting in lumbar spine strain with lower back pain, spasms, and limited spinal range of motion. These back symptoms are distinct from and in addition to my knee symptoms."

Poor claim: "My knee injury makes it hard to walk, so I want a separate rating for difficulty walking."

3. Consolidate Related Conditions

If you have multiple diagnoses for the same area with overlapping symptoms, claim them together under the most specific diagnostic code rather than separately. A higher single rating is better than risking a pyramiding finding.

4. Focus on Functional Impairment

Rather than seeking multiple diagnoses, focus on demonstrating the total functional impairment for each distinct body area or system.

5. Consult a VSO or Attorney

Before filing multiple claims for related conditions, talk to a Veterans Service Officer or VA-accredited attorney. They can help you structure claims to maximize your rating without triggering pyramiding issues.

Fighting Improper Pyramiding Denials

Sometimes the VA incorrectly denies a claim as pyramiding when the conditions actually have distinct symptoms. How to push back:

Get a Medical Opinion

Obtain an opinion from a specialist that explicitly states you have two separate conditions producing different symptoms affecting different functional areas.

Cite Legal Precedent

Key cases include:

• Esteban v. Brown (1994): Established that pyramiding only applies when rating the same manifestation or symptom twice
• Brady v. Brown (1993): Clarified when separate ratings are appropriate

Create a Symptoms Chart

Build a clear chart showing each condition, its unique symptoms, and the distinct body areas and functions affected. Demonstrate there is no overlap.

Appeal to the Board

If the Regional Office denies your appeal, request a Board of Veterans' Appeals hearing where you can explain why your conditions are distinct. Bringing a VSO or attorney is highly recommended.

Pyramiding in Mental Health Claims

Mental health pyramiding is the most complex area because the VA uses a single General Rating Formula for all mental health conditions. Multiple diagnoses (PTSD, depression, anxiety) are almost always consolidated into one rating based on overall functional impairment.

Successfully arguing for separate mental health ratings is very difficult. It requires completely separate traumatic events with clearly distinct symptom profiles, and usually requires expert medical evidence and legal representation.

Next Steps

Structuring your claims correctly from the start maximizes your rating and prevents future reductions. Use the Veterans Benefits Finder to understand how different rating levels affect your benefits, and consult with a VSO before filing multiple claims for related conditions.