Arthritis, scars, and metallic foreign bodies

[Hokie99]

I was shot in the left distal thigh and while in the service. I currently have a rating of 40 percent for code 5314 for the severe muscle loss due to high velocity through and through missile. I have since been diagnosed with bilateral secondary arthritis to both knees. The doc said it was secondary in both knees due to the wound. The doc also noted during the X-ray that I have metallic fragments from the bullet in my knee. Also my service records revealed degenerative changes to the left meniscus of the knee found while treating the gunshot wound. It was Not related to the wound but I had no knee injuries prior to entering the service.  I have a VSO appointment but want to make sure I have some knowledge  to have a better and more informed meeting with him. I filed the first claim back in 1995 on my own with no help and think I left a lot on the table. My questions are as follows:

1.Since I was rated for the muscle loss would claiming the scars be pyramiding?

2. Is there a rating for leftover metallic foreign bodies from the bullet, or would this be pyramiding as well?

3. I know the arthritis is separate and should be secondary based on the Docs notes. I see that most ratings for arthritis are ten percent. But I plan to file for the meniscus as well since it was documented in the 1995 service record. Would the arthritis and the meniscus be pyramiding or even considered the same condition?  

4. Also, the bullet fractured my patella which was put back together with titanium screws. Could this be claimed as a separate disability?

 

[Buck52]

 The rule against pyramiding is an exception, in that it prohibits compensating a veteran more than once for the same disability or same manifestation.

What does the VA mean by “same disability” or “same manifestation”? The important thing to remember is that if you are looking to receive separate ratings as a result of a single disease or injury, the argument that needs to be made is that you suffer from a variety of symptoms that are covered by diagnostic codes that are not duplicate and do not involve overlapping symptomatology. For instance, a veteran who suffers from disfiguring scars, painful scars, and facial muscle damage that limits functionality can be rated separately under each relevant diagnostic code even though the conditions are the result of the same disability. The key in these cases is that the same symptoms cannot be used to support two separate ratings.

Another common example of pyramiding involves mental disabilities. Quite often a veteran will suffer from more than one mental disorder, such as PTSD and bipolar disorder. It is often difficult to determine what manifestations are the results of one mental disorder, and what manifestations are the results of the other. Therefore, typically all mental disorders are rated together. But, it is possible for a veteran to receive separate ratings for two distinct mental disorders if there are manifestations of one mental disorder which are not manifestations of the other. But note, this would not be a simple argument to make and would most likely require an independent medical opinion that describes how each mental disorder has separate manifestations.

As you can see, pyramiding is a complicated issue, and is it also one that the VA often gets wrong. The VA has had a tendency to over-apply the anti-pyramiding rule, so if you have a disability that results in separate symptoms that do not overlap, you may be able to get separate ratings for each condition, and you should appeal your rating decision if the VA fails to separately rate each condition. For such cases, it would likely be helpful to get an independent medical opinion that shows how the single disability results in distinct, separate conditions that do not have overlapping symptomatology.

SO RECHECK ALL YOUR DIAGNOSTIC CODES!!!

Edited July 17, 2019 by Buck52