hypertension What's Pyramiding, And Why Is It Bad?

[hedgey]

Went to a new VSO yesterday and frankly, I wasn't impressed. I have a claim in for increase in a condition I've had for 20+ years plus new problems as secondary, and for PTSD from events 20+ years ago as well.

The physical issues have been evaluated. From the reports, the increase has been determined to be related to the SC, so yay for that :D. One of the other issues that I was claiming secondary was called "at least as likely as not" and the other was called "not related to". This one I'm working on getting a nexus written by a private doctor, and I'm going through Physical Therapy (ordered by the VA doc). We'll see what happens with that.

So I was explaining all this to the new VSO guy. I told him that my VA specialist had specifically diagnosed other secondary issues and was elaborate in the progress notes that had been from visits in January. I asked him if I should submit these notes as additional information, since they were so recent, and he said "oh, they have all that already". Okay...

Then I asked about the PTSD claim, told him what I had for evidence, etc. I asked him if I should provide copies of my latest (Feb) progress notes... again "oh, they'll have that too." I mentioned that maybe I should have filed for Depression secondary to chronic pain. He said no, that would be redundant, go with the PTSD because that umbrella would cover everything.

So I asked whether I should file for hypertension due to either chronic pain or depression. That's when he said I'd be pyramiding. He didn't elaborate because he had another person waiting. He said to just wait and see what happens.

I didn't give him POA. I was kind of left flat with his confidence about the raters having all my records.

[carlie]

Hedgey,

Pyramiding is not bad - it's just not allowed.

The info and link below describes pyramiding for you.

As far as your medical evidence goes - do not leave it to VA

or a VSO to gather it.

Get it yourself and submit it all at your VARO

and get date stamped copies of it all.

jmho,

carlie

http://ecfr.gpoaccess.gov/cgi/t/text/text-...7.9&idno=38

§ 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.

[fanaticbooks]

I agree with carlie.

Ended up having a VSO for hubby's NOD but I did all the work in gathering, organizing and writing a report that the VSO then submitted through his organizations' negotiator to the VA's DRO.

By pointing stuff out that had been missed originally, it eliminated a lot of hunting and missing at the DRO.

That's how my website came to be. Thought it might be useful for others to see steps that can be taken to help them put their stuff together.

Listen to what Carlie says. Good advice. Bottom line as others have said in here, it is your claim and you are in charge of it.

I wish you good journey.

fanaticbooks

[john999]

As Carlie says if it is important evidence get date stamped copies. You will sleep better at night. If the VA can lose it they probably will lose it.

[jbasser]

Hypertension is a separate rateable disability. There is not much room for Pyramiding. The regs state that hypertension is to be rated separate and that included heart disease.

That VSO you spoke to is a real winner. I would even use the word Moron.

If that is the best you got, Your better off canning this chump and pick up another one.

Another case of a VSO giving bad advice.

I have no room for patience with them.

J

[hedgey]

Hypertension is a separate rateable disability. There is not much room for Pyramiding. The regs state that hypertension is to be rated separate and that included heart disease.

That VSO you spoke to is a real winner. I would even use the word Moron.

If that is the best you got, Your better off canning this chump and pick up another one.

Another case of a VSO giving bad advice.

I have no room for patience with them.

J

Yeah, that's what I thought, too. And this is the guy who gets his paycheck from the State, so it's his full time job.

Thanks for the explanation, carlie. I don't think that adding hypertension as a secondary would be pyramiding , but the VSO sure did. Maybe it was the possible work he'd have to do that he didn't like...

[fanaticbooks]

One other thought....

Pyramiding is probably something the VA is used to seeing in claims. The veteran does not know all the ins and outs of what is and what is not doable.

If it were me, I would examine the Schedule of Ratings, note all that pertain to you, and then file for them with documentation if possible.

All they can do is say no and you would be no worse off. BUT then again there may be something in there such as hypertension that was missed or ignored by a VSO that is allowable.

The VA is the final decision maker. The VSO isn't.