Tbi Rating Erased Due To Pyramiding?

[Scout Swimmer]

Hi everyone.

I was awarded 40%.TBI back in 2009.

I put in for depression at the behest of my physician and was just awarded 70%

It would have brought my total points to 95 so I was really happy until I read the rest of the decision.

Essentially, they cited "pyramiding" and erased my TBI, which really screwed me.

Does this sound right? I thought that rule was for multiple MH contentions that overlapped, but how do they site pyramiding for a physical injury with an MH?

Do I fight this or is this a normal thing?

[Vync]

They did the same thing to me, but my issues were GERD and IBS, even though they are on the opposite end of the digestive trac t. The TBI still exists, but the rating was overridden with the higher 70% rating. It's not like you would lose any special benefits of being a TBI patient. It does kinda does suck because 40% + 70% would have come out to an 80% combined rating. If you are not able to work, an option worth taking would be IU because you have a single rating >= 60%, which if granted could put you at 100%.

Someone else with more expertise should be able to help.

[NavyWife]

I've seen this done with TBI and PTSD however I've never seen it done with depression and TBI.

The answer lies in your C&P exam. Towards the top there is a question that says something like, "Can the symptoms be separated"? If the Dr. marked "no", then maybe it is reasonable that VA would combine them. However if the Dr. marked " yes", Then VA made an error in combining them.

You should probably look at BOTH your TBI C&P exam and your depression C&P exam.

TBI is one of the most complicated contentions that can be rated. Very frequently there are errors made. some regional offices make errors on 50% of TBI cases and some as high as 90% error rate.

In CFR 38 it says this under the TBI rating:

"Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled “Evaluation Of Cognitive Impairment And Other Residuals Of TBI Not Otherwise Classified” with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition. "

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5#38:1.0.1.1.5.2.116

[Navy04]

In my situation, I have PTSD and a slew of other mental conditions grouped together, but my TBI is rated with Migraines at 30%, witch is totally off the wall. I too have Crohn's, Baretts, and GERD all rated as 30% for Crohn's. You really never know with the VA. The VA wonders why there system is so off track, look at how the Raters seem to rate Vets disabilities different in each case, and group others that don't make sense.

[Scout Swimmer]

Navywife, to answer your question, the doctor checked no for “can symptoms be separated", on my C&P.

Navy04, that’s so weird. My TBI is the cause of my migraines, yet rated separately.

I'm beginning to think they have no rhyme or reason for anything they decide.

[marine0816]

My case has pyramiding in play also. But if they take mine out and leave the rest, I should still get 100%. Would you mine posting the letter they used to screw you?

[NavyWife]

Also compare both of your C&P exams and see exactly what symptoms they marked you for on the TBI, which gave you the 40% rating. If it is for the same symptoms that you have for depression then it makes sense that they would combine the rating. However if it is for different symptoms, then they probably made an error.