Pyramiding

[joevet]

Does the VA consider Code 7005 Ischemic heart disease, Arteriosclerotic heart disease, Atherosclerotic heart disease, or Coronary artery disease (CAD) and Analogous Code 7099-7017 coronary bypass surgery as Pyramiding?

Conditions that are not in the VASRD are rated “analogously” with a condition that is in the VASRD. “Analogous” in this case means the condition that is closest to the overall condition, that best describes the main symptoms, or that has the same treatments. When rating a condition on an analogous code, the final code will most commonly look like this: 8099-8003. The first four-digits tells us that this condition is rated analogously. The second four-digits is the code the condition is rated on. To determine the first four-digits, take the first two digits of the second code and add 99 to the end. 8003 = 80__, and then just add 99 = 8099. Then add the second code to it with a hyphen between: 8099-8003

A coronary artery stent is a tube that is surgically placed in the arteries of the heart to keep them from collapsing. It is Analogously rated under code 7017, coronary bypass surgery as 7099-7017.

Edited October 16, 2017 by joevet

[broncovet]

Good question.  If you can figure out, "what the VA will do" when xy happens, then you need to buy a lottery ticket immediately.  

Remember, VA is NOT a unified body, its a group of a big bunch of employees, each with differing Views on Veterans, and VA laws.  

However, I suggest you treat it like symptoms of, oh, say, "mental disorders".  

There are many mental disorders:  PTSD, MST, depression, bipolar, shziphrenia..to name a few.  All of these are lumped into one for "mental disorders" based on your symptoms.  

Once service connected, "the symptoms" establish the percentages, so it does not matter if its CAD, IHD, etc, etc...you get paid for "one" set of symptoms, no matter if you have 8 heart diagnosis and problems.  

If you get that you dont get paid for IHD, and COPD, and CAD, etc., etc.,  but you instead get paid for symptoms..such as "shortness of breath" or "inability to work over 2 hours" etc, that may help understand pyramading.  You get paid for your symptoms ONLY ONCE regardless of what disease caused it.  

[joevet]

The bad thing about the VA is you have to file for whatever ailment that you have and not leave it to them to read the medical report and decide in your best interest. You can have a dozen doctor statement all with specific information about your worst medical condition, but if you don't file directly for that condition the VA will not consider it for disability. Don't made the mistake that the VA is on your side and working on your behalf. They will screw a veteran on every chance available. One must know, or try to find someone who does actually know which is very difficult, how to file correctly. For example you can have conditions under Code 7005 and 7017 but they are different. Disability under 7017 will pay 100% for three months at least to start while 7005 will not. If a veteran does not file under a particular Code, the VA will always choose 7005 to beat the veteran out of the three months of 100% compensation. Never leave it up to the VA to make decisions for you unless you want a good screwing.

[broncovet]

Well, yes the VA will mess you over every chance they get.  That is why I recommend not getting "to" specific when applying for benefits.  The law says that a VA claim must a be in writing, show intent to apply for one or more benefits, and specify the benefit sought.  

Vets come from many different education levels, and its not a good idea to be "too smart".  You are "probably" not a doctor and you probably can not diagnose and treat your own diseases.  A doctor of medicine does that.  

And, a doctors report is required for your comp benefits.  You dont need to self diagnose, and you dont need to know the DC code to get benefits.  Vets can "point" to the body part that hurts.  We dont have to apply for a bilateral sublexation of Cervical spine 6, you are better off requesting benefits because of a "bad back".  Why?

It can delay your claim.  If you applied for a sublexation of cervical 6, and a doctor diagnoses you as (something else), then you may have to start over.  But, if you say your back and neck hurts and you want benefits for that, it encompases a wide variety of diagnosis that a doctor will make.  To get service connection you need the "Caluza triangle of these:

1.  Current diagnosis (by a doctor).  Self diagnosis wont work.  

2.  In service event or aggravation.

3.  Nexus, or medical link.  The doctor needs to make a statement similar to :  The Veteran C6 sublexation, and bulging disk, is "at least as likely as not" due to jumping out of airplanes during miltary service.  

[joevet]

This is exactly what I was talking about! Never give the VA an opportunity to screw you because they will not pass up that chance.

The VSO filed simply 'Heart Disease'  for me when I first had my heart problems. The doctor statement listed three aliments: Atherosclerotic cardiovascular disease, Coronary artery disease (CAD) and Percutaneous coronary intervention (PCI) angioplasty with two stents.

The first two heart conditions have a compensation rating of 60% and the PCI has a  100% compensation rating for a minimum of  three months. Give you one guess which heart aliment our friends at the VA assigned me for my compensation rating. Of course, if you have ever had any dealing with the crooks at the VA, you know without a doubt they used CAD so as to screw me out of at least three months of the higher compensation.

Again, never leave it up to the VA to determine what your diagnosis should be. You have the obligation when filing to be very specific as much as possible, using your doctor statement, to file using the proper Code otherwise I guarantee you that the VA will screw you every time. You can't count on some one else to look out for your best interest. That is your responsibility. You can play dumb if you wish, but you will pay the penalty.

[broncovet]

Of course VA will screw you every chance they get!!  That is why you file for what the doctor diagnosed, not what you think you have.  A docs diagnosis is required for benefits anyway.  File for:

Atherosclerotic cardiovascular disease, Coronary artery disease (CAD) and Percutaneous coronary intervention (PCI) angioplasty with two stents.

[joevet]

As I have stated, the VSO had already filed under 'Heart Disease'. Filing for all three of these heart conditions instead of simply filing Heart Disease would still leave it to the VA to assign a compensation rating of their choosing which would be the one paying the less compensation. The veteran, or a VSO that knew what he/she was doing, would have filed under PCI even though all three were listed on the medical report. This would have prevented the VA from screwing the veteran.

No one has said, or even implied, that a veteran should file for what he thinks he has, but file using the medical diagnosis as provided by the doctor using the specific diagnosis that would be the most beneficial to the veteran. You should never file several ailments under a broad medical heading such as 'Heart Disease' or 'Mental Disorder' and leave it to the VA to choose the ailment for compensation. The veteran will get screwed every time.