Pyramiding

Jason Perry

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Here is the text of 38 CFR Section 4.14 (which is part of the VASRD):

"§4.14 Avoidance of pyramiding.

The evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. Dyspnea, tachycardia, nervousness, fatigability, etc., may result from many causes; some may be service connected, others, not. Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation and the evaluation of the same manifestation under different diagnoses are to be avoided."
 

Jason Perry

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To explain this, remember that the VASRD compensates for functional limitation. If you have multiple conditions causing limitation to the same body part, you can't "double dip" on getting compensation for the same limitation.

Example, if you have a gunshot wound to your shoulder and also have arthritis in that shoulder, you can't get two ratings for that shoulder. You will get the higher evaluation, though.
 

RayH

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How are ankles evaluated? Say, if you have limited ROM in both ankles due to arthiritis.

V/r
Ray
 

Jason Perry

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The pyramiding rule applies to the exact same body part (not to a pair of body parts), so if you have both ankles compensable you combine the ratings but also add ten percent of those combined ratings for what is called the bilateral factor.
 

RayH

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Jason,
So that would be for an exmaple, 20% left then 20% right plus 10%.
100%-20%= 80%. 80%-20%= 64% then 64%-10%=57.6%. leaving you with 42.4% disabled?
 

Jason Perry

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No, those numbers would be calculated like this:

20% combined with 20% equals 36% (20% of 80 is 16% added to the original 20%). Take an additional 10% for the bilateral factor and you have 3.6%. 36% plus 3.6% equals 39.6% rounded up to 40% (note in this instance, the additional 3.6% does not result in any higher rating as the rounding up would have equaled 40% anyways).
 
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