May 20, 2025 • 31 mins
Leah and Rebecca Deming from Provet Legal dive deep into the topic of "pyramiding" in VA disability claims. They explain how the VA prevents veterans from receiving multiple ratings for the same symptoms, using real-world examples involving mental health, respiratory conditions, and TBI. The conversation is packed with practical insights on how to avoid rating mistakes, maximize benefits, and when to seek legal and medical support. It's a thorough, relatable guide for veterans who want to better understand the rating process and protect their rights.
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At Prestige Veteran Medical Consulting, a veteran-owned company, we specialize in Independent Medical Opinions (IMOs) known as Nexus letters.
The purpose of this channel is to empower YOU, the veteran, to take charge of your medical evidence and provide you with valuable educational tools and research to guide you on your journey.
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Leveraging an extensive network of licensed independent medical professionals, all well-versed in the medical professional aspects of the VA claims process, we review the necessary medical evidence to incorporate in our reports related to your VA Disability Claim.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Leah Bucholz (00:06):
Hey guys, it's Leah B from Prestige Veteran
Medical Consulting. I'm a USArmy veteran physician assistant
and former compensation andpension examiner. Today I have
Rebecca Deming from ProVet Legalon and we're gonna discuss a
topic that I find extremelyinteresting and I've been
wanting to do this videoforever. So I'm so glad that
she's on today to do it becauseit's it's something that I think
is so relevant to veteransclaims and that's pyramiding. So
(00:30):
Rebecca, before we jump in, doyou want to I know you've been
here several times and most ofour viewers probably know you by
now, but for those Those of themwho don't know you, can you tell
them a little bit aboutyourself?
Rebecca Deming (00:42):
Sure. I'm the owner of ProVet Legal. It's a
law firm based in St.Petersburg, we represent
veterans nationwide and evensome living overseas and their
family members in VA disabilityclaims. And my husband is, was a
twenty seven year Navy veteran.
(01:03):
And I got into this area ofpractice after working with
military members for a longperiod of time when he retired.
Love So working with veteransand happy to be on your channel,
Leah.
Leah Bucholz (01:15):
Yeah, and I have never really said this in a
video before, but it just cameto my mind that I just want to
say that I think Rebecca is anamazing attorney and an amazing
ethical person. That's why Ihave her on so much because I
work with a lot of, amazing VAattorneys, accredited claims
agents, VSOs, and I think theyall are wonderful and do so many
things for veterans. But, Imean, Rebecca is just top notch
(01:36):
when it comes to the way thatshe her brain works, the way
that she shows up for herclients, the way that she is
very responsive and and addsthat personal touch, I think, is
so wonderful. And that's why Ijust I've enjoyed getting to
know her over the years, and andI'm so glad that she's, so
willing to provide her insightsto you guys. So, hopefully, we
(01:58):
can convince her to get her ownchannel going here soon so you
guys can pour into her moreoften.
So I'm gonna keep nudging her onthat.
Rebecca Deming (02:06):
Leah, you're making me blush.
Leah Bucholz (02:07):
No. Well, I'm for real. So, before we before, I go
too off off topic, can you tellus what pyramiding is?
Essentially, what is thedefinition of pyramiding in the
context of VA disability? Sure.
Pyramiding is
Rebecca Deming (02:24):
basically VA's way of saying that you can't
double dip and get paid for thesame symptom under a different
diagnostic code. So if, youknow, if you've got three
different diagnoses That allimpact your ability to breathe
and they're all you've got COPD,asbestosis, sleep apnea and
(02:49):
asthma, they're all impactingyour respiratory function.
You're not going to get three orfour different ratings for that.
VA is going to say, okay, whichone's the highest one and we're
going to rate that one orthey'll kind of combine. I say,
combined with technically notthe right word, but they will
loop them under one code andgive you the highest rating
(03:11):
allowable under law for the oneof them.
Leah Bucholz (03:14):
Yeah, another one that I see a lot is just like
mental health conditions. Solike depression and anxiety.
There's a lot of overlap inthose symptoms. You may have
anxiety as a symptom of some ofyour depression also. They may
be distinct diagnoses in somecases, but sometimes those
things are subsumed in oneanother.
(03:35):
But again, we can Yeah,
Rebecca Deming (03:36):
for mental health it's always going to be
rated under the mental healthdiagnostic code. And we can get
into how TBI can sometimes bedifferent. But for mental health
it's always rated. So even ifyou have even if you're like,
I've got two very distinct, I'vegot my anxiety and when I've got
my anxiety, it makes me notsleep and I get nervous in
(04:00):
social settings and act out andI've got my depression, which
makes me sleep all day and twoseparate conditions that have
separate onsets and separate,you know, whatever face still
going to say, nope, those arepyramid. Those affect your
mental health and your abilityto function in your social and
occupational impairment.
And so because of the way thatthey rate them, you're not going
(04:21):
to get two separate disabilityratings for mental health.
Leah Bucholz (04:23):
Sure. So how does VA determine whether a person's
conditions are subject topyramiding?
Rebecca Deming (04:29):
So they, you know, the kind of overarching
answer is they're looking atwhether the same symptoms are in
the rating code or appear in twodifferent rating codes that. The
veteran would otherwise qualifyfor And then they're going to
give you the higher one of thetwo. They're not going to give
you both. The more nuancedanswer is there are very
(04:52):
specific guidelines in VA'srating schedule that will say,
you know, for this one, youcan't rate them both, choose the
one that most accurately orprovides the higher rating for
them. And so there are somewhere I always get sort of
(05:13):
surprised with the knee, You canget one rating for limitation of
flexion, one rating forlimitation of extension, and one
rating for instability.
And there's some nuance andthat's just because that's the
way the code is written. Soknowing those nuances can be
really helpful to maximizing therating for someone and also not
(05:35):
wasting your time if you're, youknow, like you said, if you've
got depression and anxiety, likethey're two different things and
you're spinning your wheelstrying to get a separate rating
and VA is like, we are nevergoing to give you a separate
rating for those two thingsbecause they all get rated under
the mental health code.
Leah Bucholz (05:48):
Yeah, or they might even say, hey, guess what?
You opened this claim foranxiety but you're rated for
depression and now we think thatyour depression has improved.
And it might not have, right?But just weird things can
happen. Anything can happen.
You got a new headache on yourhands, right? Yeah. So can you
explain the difference betweenseparate and overlapping
disabilities in terms ofpyramiding?
Rebecca Deming (06:09):
Sure, there can definitely be overlapping
disabilities and there's thingsthat are related. So you can
have, let's say you havediabetes and diabetes causes,
you get one rating for actuallyhaving diabetes and you get one
rating because you've gotneurogenic bowel or neurogenic
bladder and then one rating forthe peripheral neuropathy, and
(06:29):
it's all really related to yourdiabetes, but it's affecting
different body parts anddifferent systems. Then you're
going to get those separateratings for that. But with
pyramiding VA is looking at, isit impacting one body part, one
system, one function of that onesystem? So, it is sort of
(06:49):
nuance, like on your head, couldhave a scar on your face, you
could have headaches, you couldhave dry eye, you could have
rhinitis and you could have amouth issue, know, that's all in
your head, but those are goingbe separate issues because of
the way that VA says no, likeone's impacting your vision and
that's a separate function.
One's impacting your nose andrespiration. One's impacting
(07:13):
your ability to show up to work,because you're getting headaches
that are kind of knocking youout too often. So VA looks at
really not just they look atboth the body part, but also
what function is impaired. Andwhether they're separate
functions that are impaired. Sothey're looking at, can I give
you a separate rating for thisimpairment and this impairment
(07:33):
and this impairment?
Or is it really all all thesethree things are just impacting
your ability to move yourshoulder? And so, since you
can't move your shoulder, youget one rating for your
shoulder, whether it's caused byyour clavicle or your I'm not
even sure, Leah, what otherpieces in your Yeah. Yeah.
Leah Bucholz (07:56):
So there's your rotator another one, headaches.
I'm getting headaches. Well, Ihave tension headaches and I
have migraine headaches. Andthen I also have just
generalized headaches. Right?
They're all headaches. Right? Orwith the shoulder, it's
impacting your ability to move.So, like, I had a labral tear in
my shoulder. I had a rotatorcuff tear.
I had, AC joint issue. I had,like, five bajillion different
(08:18):
things wrong with the sameshoulder, but I'm not gonna get
I'm not actually even rated formy shoulder because it was
unrelated to service. But if Iwas, and if it was, then, you
know, it's gonna be one rating.
Rebecca Deming (08:32):
Right. Right?
Leah Bucholz (08:33):
So what are what are some of the potential
consequences for a veteran ifthe VA finds that their
disabilities are pyramided?
Rebecca Deming (08:41):
So you're only gonna get that one rating
whereas you're applying forseparate ratings. And so with
VA, it's sort of like a Tetrisgame or something, and you're
trying to fit all these piecestogether to get the highest
possible rating applying VAmath, which we did a separate
video on VA math. And so some,you know, if you were if you
(09:06):
were able to get four ratingsfor that shoulder, like, that
might. Move you from 70% to an80 or 90% or something,
depending on where what else youhad. Connected.
But because you only get thatone rating, you're going to be
stuck with that one rating. Sounderstanding that's just, I
mean, I think it's, there arecertain things that you can, can
(09:30):
do sometimes to differentiatesymptoms and be like, listen, I
qualify for the 70% under thisrating code without the symptoms
that would qualify under thatother rating code. So that
really should get two separateratings because they're, you
know, you can distinguish thesethings and they impact me in two
distinct ways. Then VA willseparate them. Do sometimes see
(09:55):
them combine things thatshouldn't be combined.
So, you know, sometimes we'llhave migraines with tinnitus or
something, and they give you onerating for migraines with
tinnitus. Under the currentrating schedule, like. You know,
and that is potentially subjectto change here soon. The
tinnitus or tinnitus should geta 10% rating if it's service
(10:18):
connected. And your migraineshould be rated based on how
frequently you're havingheadaches.
And so, even if they were bothcaused by. The TBI that you
suffered when you got hit in thehead and whatever they're two
separate things that should berated separately. So sometimes
when you see those things ratedtogether, you can separate them
out and get that extra. 10%,which may or may not impact your
(10:40):
combined rating. That's whyunderstanding the VA math is
really important to know whenit's worth putting in that extra
fight.
Leah Bucholz (10:47):
Yeah, I have a friend that's another VA
attorney. Have, and he was justmentioning to me the other day,
he's working on a case forsomeone that's got neck pain and
they tied in cervicogenicheadaches, right? So those, you
know, into the same And so thoseare just, yes, it is caused by
his cervical spine condition,but it is a separate like, as
(11:09):
you mentioned earlier about thediabetes, it can affect multiple
body systems. So you've gotheadaches caused by the neck.
That's a distinct separatecondition.
Right. That legal type he'sgonna have to make, I guess. So,
you know, along the same lines,how can what are some things
that a veteran can do to presenttheir case to avoid the pitfalls
(11:29):
of permitting?
Rebecca Deming (11:32):
So for some of them, you're just you're just
stuck. If the code's writtenthat way, you know, for the
longest time, and I think thishas been alleviated recently,
you know, you couldn't getseparate ratings for
gastroesophageal reflux disorderand IBS because they both have
that symptom of epigastricdistress or like the bloating
(11:54):
and pain in the stomach. And youknow, for me, one is exit and
one is entry. I think of youresophagus and your bowels as two
separate body parts, but VAbecause the symptoms were
overlapping. If that's the case,you can argue all day long, but
(12:18):
if the code is written that youcan't have separate ratings for
them, then you're stuck.
But on some of the more nuancedones, one of the ones that we
see a lot is TBI and PTSD,because if you got blown up and
(12:38):
that shook up your head, itmight also be the cause of some
post traumatic stress disorder.They could have the same origin,
but there's some overlappingsymptoms. So with TBIs, it's
really important to kind of lookat most of the time. I think you
don't and we could do a wholeseparate. We could probably do
(12:58):
multiple a whole series on TBIs.
Most of the time you're going tobe better rated if you get
instead of having a rating forTBI, you'd be better rated for
the individual symptomsunderneath. But sometimes you
can get a separate rating forPTSD because it's the emotional,
the cognitive behavioral changesthat are happening from PTSD,
(13:20):
but your TBI is really impactingbalance and memory and cognitive
function, which is separate fromthe PTSD. Especially if they're
separate injuries and so you cankind of say it's easier for the
doctors. And this is reallysomething there's medical
professionals that will get intoit and do some testing and
evaluations to say, no, no,these symptoms here are clearly
(13:44):
PTSD and on their own they meetthe criteria for a fifty or
seventy percent rating. And thenthese symptoms are very clearly
tied to the head injury and ontheir own they meet the criteria
for thirty, forty, seventypercent rating, whatever it is.
Then we can kind of argue thatVA should separate them out. I
(14:08):
think something that's reallyhard for veterans to do on their
own. It's hard for us as legalprofessionals to do working
closely with medicalprofessionals to separate some
of those out. So, if you findyourself in a situation where,
and I hate to say, hey, it'scomplicated, talk to a lawyer,
but this is one area that Ithink it's just going be really,
really challenging if you thinkthat VA incorrectly combined or
(14:33):
pyramided two ratings and youwant to try to separate them
out, you probably want to get anexpert to work with you, or a
couple experts, you know, thelegal professional and a medical
professional to help separatethat out.
Leah Bucholz (14:46):
So are there some specific conditions that come to
your mind like the most commonones that are prone to having
this happen?
Rebecca Deming (15:01):
Gastrointestinal ones are ones that, like I said,
the TBI and PTSD or mentalhealth and TBI often get
permitted. Respiratoryconditions very frequently get
permitted. So asthma, and thisone kind of boggles my mind, but
sleep apnea would get pyramidwith asthma or COPD or
(15:24):
asbestosis. So one is, you youhave know, sleep disturbed
breathing and you're waking upgasping for air at night and the
other is you have reduced lungcapacity during the day because
of these other impairments. Inmy opinion, they're kind of
separate, but VA has determinedthat they overlap enough because
they both impact respiratory andso you're only going to get
(15:45):
whichever one is higher.
So if you qualify for a thirtypercent for asthma and a fifty
percent for sleep apnea, you'rejust gonna get that one hundred
fifty percent for the sleepapnea and they'd probably write
it down as sleep apnea andasthma.
Leah Bucholz (16:00):
Can you share some of your insight on some examples
of some successful appealsrelated to pyramiding cases?
Rebecca Deming (16:12):
Sure, I mean I think it really comes back to
having the right medicalexperts. I mean sometimes
there's cases where VA just veryclearly misread the regulations
and they're peer rating stuffthat, like the tinnitus and the
migraines. There is nothing inthe migraine rating code that
(16:35):
mentions ringing in the ears sothe symptoms of. Tinnitus or
tinnitus are nowhere in therating code for migraine
headaches. So it's just notappropriate to say that it's
overlapping symptoms.
So that one, we probablywouldn't need a legal expert to
separate them out. We would justgo into the VA schedule for you
(16:56):
to disabilities, pull, and I'dprobably do a higher level
review initially. Might need toend up going to the board and
say, hey, because they don'toverlap, here's the rules and
regulations on pyramiding. Theseneed to be separated out and you
need a separate evaluation. I'dalso be looking at the C and P
exam to see what symptoms wereshown in there.
Leah Bucholz (17:21):
That example is one that would be pretty
straightforward if you did ahigher level review and you were
like, come on, like, we knowthat these two aren't combined,
but I guess common sense doesn'talways prevail. I would assume
that another rater would look atthat and say, oh yeah, clearly
this was a mistake and we needto separate these.
Rebecca Deming (17:39):
Right. Yeah, and so we have seen a few of those.
Luckily, I think that those arerare. I mean, there's not a
whole lot of times where they'rereading the. Under one code when
it's really multiple conditionsthat impact different body
(18:01):
systems or functions.
Think, yeah, the simple ones arepretty rare, but if you see
those where it's like, wait aminute, they rated you know, my
balance and my headaches is onecondition or something. That one
(18:23):
actually probably wouldn't bethat simple because you'd want
to be looking at, do you havevestibular migraines and are you
only losing balance at the timewhen you're having a migraine or
is one like, hey, I'm constantlyoff balance. And the other one
is, I have migraines that knockme out for a few hours at a
(18:44):
time.
Leah Bucholz (18:44):
Sure. So aside from accredited VA attorneys,
what are some other resources ofsupport or support that veterans
can access when they're dealingwith this?
Rebecca Deming (18:54):
I mean, you wanna get froggy, I like to pull
up the VA schedule of rateddisabilities and go right to the
source. And my favorite resourcefor that is the Cornell Law
website because of the way thatthey're written. I think it's
not paragraphs and paragraphs oflegalese. It kind of has the
(19:17):
hyperlinks or the condition, thecode, and then it's written in a
way that is pretty easy to findit and break it down. So you can
look at and be like, oh, okay,there is a, I mean, if you want
to read through that, you mightbe able to find the answer on
your own that.
Yeah, is never gonna give youseparate ratings for two
different mental healthdiagnoses or something. Or you
(19:41):
might look at it and say, Hey,ringing the ears is not a
symptom listed under the ratingcode for migraines, so why did
they combine those and not giveme two separate ratings?
Leah Bucholz (19:54):
So do you feel like there's a lot of
misconceptions that you hearregularly from veterans about
pyramiding that you have todispel?
Rebecca Deming (20:03):
I think the biggest one is that people just
think that every diagnosis thatthey have should be a separate
rating and not understandingthat VA is really looking. I
mean, I think in general, if youstep back, VA is looking at, at
least in theory, they're lookingat you as the whole person. And
so how do these differentdisabilities impact you? So if
(20:24):
you have one thing on your rightarm and one thing on your left
arm and one thing on your bowelsand one thing on your lungs,
that's going to impact youdifferently. If you have like
four different things on yourlungs, well, okay, we're just
looking at how those worktogether.
You might get a higher ratingbecause of the way that all
these things are impacting yourrespiratory function, but you're
(20:47):
only going to get the one ratingfor it. I think people just
assume that because they havemultiple diagnoses, they're
going to get a separate ratingfor every diagnosis that they
have.
Leah Bucholz (20:55):
How often do you actually see that VA incorrectly
pyramids things? I know we'vetalked a lot about like examples
of that, but how often do youthink this happens?
Rebecca Deming (21:05):
I mean, I think it's frequent enough that it's
worth having this this episodeand and talking about it, but I
don't think it's, like, all thetime. I you know, I I'd say it's
probably less than 5% thatthey're incorrectly permitting
stuff. You know, like one in 20where it should be separated and
(21:27):
they just sort of were like, oh,yeah, it's, you know, all from
the same injury and thereforeit's all one rating. You're
like, no, that's not what theregulations say. That's not what
the medical evidence shows.
They're really they should gettwo separate ratings. If I had a
number on it, I'd say one intwenty.
Leah Bucholz (21:44):
One in twenty of pyramiding cases
Rebecca Deming (21:48):
are that are inappropriately pyramided. Yeah.
Okay.
Leah Bucholz (21:51):
That's I mean, I I feel like that's a that's a good
enough it's not like you said,not that you see it every day,
but it's frequent enough thatit's annoying and people have to
deal with it semi regularly.
Rebecca Deming (22:05):
Yeah. I mean, I think that kind of brings up a
broader issue, not to go down awhole rabbit hole of the VA's
rating scheme in general isfairly complex. I mean, you can
access the schedule fordisabilities online and you can
read through it. But the nuancesof how to separate stuff out or
pyramid it or not pyramid it orwhen to pyramid it and how to,
(22:30):
you know, if you only claimdiabetes, but then the evidence
shows that you've got theseother tertiary conditions that
are caused by the diabetes thatVA should there's just there's a
lot of nuance and a lot ofobligations that's on VA, and
there's humans at differentlevels of government employee
that are applying these complexregulations. So there's a lot of
(22:53):
errors.
I think sometimes people willget a rating decision and
they'll be like, but why did VAdo this? And it's like, you
know, it's like asking whyyou're this is going to sound
insulting, but, you know, likeasking why your two year old is
tantruming. You know, theybecause it's, you know, because
they're two years old, becausebecause VA is a big bureaucracy,
(23:14):
they're going to make mistakes.Like, I wouldn't always ascribe
a rationale to it or think thatyou have to have a bigger fight
than you do. I mean, sometimesthe stuff that we need to fight
does require us to get a medicalexpert that's going to do
additional testing and reallydistinguish these two separate
conditions and how they impactthe veteran in very distinct
ways.
(23:34):
But sometimes it's just simpleVA error and
Leah Bucholz (23:40):
Yeah, unfortunately there's, like,
human process there. Right? Sothere's a human process, and
there's human bias. There'shuman mistake. There's human
whatever.
Right? So like any other, youknow, major bureaucracy
organization, whatever, there'sgonna be, unfortunately, things
(24:01):
that have to be fixed orrelooked at, etcetera.
Rebecca Deming (24:05):
Yeah. And if if it's a really simple, you know,
these two things should not bepermitted and you took the time
to look at the code and you feelcomfortable filing a higher
level review on your own. I knowwe usually talk about like, hey,
you know, if you're getting intoappeals, it's worth talking to
an accredited claims agent or anaccredited attorney. But
sometimes, you know, people wantto do stuff on their own and
(24:27):
they've done the research andthey just feel really confident.
You can write, you you do wantto write as much as possible.
You probably would want torequest an informal conference
with the Decision ReviewOfficer. But if it's really just
as simple as like VA, know, thisrating, I don't want say VA
didn't know what they weredoing, this rating officer who
wrote your decision didn't knowwhat they were doing. And you
(24:50):
can kind of pinpoint that forthe Decision Review Officer, you
might be able to get itoverturned in about four months
is what we're seeing higherlevel reviews take currently as
of April 2025 when we'refilming. Their timelines are
constantly shifting, but yeah,you might be able to overturn it
on your own by just kind ofpointing it out and following
(25:11):
that higher level review.
Leah Bucholz (25:13):
So I guess in your experience, how has the
interpretation of period of peermeeting evolved over time? And
then what trends do you thinkmay, you know, what is it going
to look like in the future? I
Rebecca Deming (25:33):
think that some of the more complex stuff might
be ripe to take on appeal allthe way up to the courts and
federal circuit if we need to,because VA has regular So, you
know, you've got the statutesand the regulations that apply
the statutes, and then you'vegot the way that the agency at
(25:54):
the lower level applies thoseregulations. And so sometimes I
think there's VA puts, theagency puts overly restrictive
interpretations of the rules onthere. So I think there are some
areas where, you know, couldreally push back as as legal
(26:15):
advocates and try to separateout the. Some of the things that
really are affecting veterans indifferent ways. I also think
that some of the testing for TBIhas gotten a lot more advanced
over the past few years, overthe past ten years.
(26:37):
In the past it would be like,Oh, we can only really determine
what the TBI did when we do abrain autopsy after you pass.
Now I think they're able to dokind of more imaging and more
testing and kind of separate outlike, okay, well this is really
a PTSD symptom and this isreally a TBI symptom. And then,
yeah, it's like logic puzzles,like, you know, you've got to
(27:03):
look at the rating code andespecially something as complex
as a rating code has multipledifferent. Places you're kind of
saying, you're looking at theirmedical records and saying they
have these symptoms documentedthat aligns with the, you know,
these sections of the ratingcode. So we're pulling these
pieces together and kind ofdiagramming it.
And if you love logic puzzles,then this is a good area to get
(27:28):
into and work on for yourself.If these things make your head
spin. Don't drive yourself crazyand hire someone to come in and
do the work for you and kind ofpull it apart and figure out
where what additional evidenceyou need.
Leah Bucholz (27:43):
Yeah, I'm interested to see what happens
and I'm sure we'll do somevideos on this here over the
next year about what's going tohappen with tinnitus and how
that's gonna get permitted andlumped in with other conditions.
And we won't go down that rabbithole, but that's gonna be one
that I think has a lot of talkhere coming up pretty soon. Then
(28:04):
also the sleep apnea and asthmachanges, which, know, again, we
can do some videos when thosethings come to fruition, think,
especially the tinnitus is gonnabe a big one for us to discuss.
Rebecca Deming (28:20):
Yeah, I mean, think sometimes these
regulations come into effect andthe changes get made and it
makes it easier for us to getcertain things separated out.
And then some of the regulationsthat are in the pipeline are
going to make it a lot morechallenging for veterans to get
adequately rated. And so peoplethat were easily getting 90 or
100 before, if they apply now,or if they apply after these new
(28:43):
regulations come into effect,are going to not get those
ratings or have to kind of thinkabout other body systems and
other claims that they mighthave in order to cover the same
ground.
Leah Bucholz (28:55):
Right. Well, that's pretty much I had, all
those the questions I had. Isthere anything that you can
think of that we missed that youthink is important to touch on
for pyramiding? Well, think
Rebecca Deming (29:09):
it's just a very fact specific situation, on
whether it's something that'ssimple misapplication of the
regulation or if it's, in yourcase, you've got very distinct
symptoms and talking to aprofessional and kind of working
through those things withsomeone who's had more
experience in pulling them apartis going to be helpful for most
(29:30):
people. And then, yeah, if youhaven't seen the video on VA
math, I think this video fitsreally well into that video in
terms of understanding. Causethere's times where you might
say, I really want to pick apartthe headaches from the tinnitus
and once it's only going to moveyou from 87% to eighty nine nine
(29:50):
percent, either way it's roundedup to ninety percent. And so
you're picking this big fightand you're not going to get any
back pay out of it anyway or anyadditional monthly compensation.
So if you haven't seen the videoon VA Math or the two videos on
VA Math, go back and watchthose.
Leah Bucholz (30:05):
Yeah, definitely check those out. And if you
would like to get in touch withRebecca at Pro Vet Legal, I'm
gonna put a link to her websitein the description of this
video. Or you can just go overto Pro Vet Legal, to her
website, it's provetlegal.com,right? Yes. And you can
certainly, know, have aconsultation with her and see if
(30:27):
maybe you guys would be a goodfit for one another.
Also, if you're looking for justlegal assistance in general,
your local VSO is always anoption that you can, especially
for new claims, you can always,reach out to those guys and and
they may be able to assist youas well. So as always, thank you
for hanging out with us today,Rebecca. And everybody please
(30:50):
drop some comments and like andsubscribe so that you can get
some more information. And letus know if there's any other
topics that you guys would liketo hear us talk about in the
future.
Rebecca Deming (31:01):
Awesome. Thank you for having me, Leah. Thank
you guys for watching. Alright.See you guys later.
Hey guys, it's Leah B from Prestige Veteran
Medical Consulting. I'm a USArmy veteran physician assistant
and former compensation andpension examiner. Today I have
Rebecca Deming from ProVet Legalon and we're gonna discuss a
topic that I find extremelyinteresting and I've been
wanting to do this videoforever. So I'm so glad that
she's on today to do it becauseit's it's something that I think
is so relevant to veteransclaims and that's pyramiding. So
(00:30):
Rebecca, before we jump in, doyou want to I know you've been
here several times and most ofour viewers probably know you by
now, but for those Those of themwho don't know you, can you tell
them a little bit aboutyourself?
Rebecca Deming (00:42):
Sure. I'm the owner of ProVet Legal. It's a
law firm based in St.Petersburg, we represent
veterans nationwide and evensome living overseas and their
family members in VA disabilityclaims. And my husband is, was a
twenty seven year Navy veteran.
(01:03):
And I got into this area ofpractice after working with
military members for a longperiod of time when he retired.
Love So working with veteransand happy to be on your channel,
Leah.
Leah Bucholz (01:15):
Yeah, and I have never really said this in a
video before, but it just cameto my mind that I just want to
say that I think Rebecca is anamazing attorney and an amazing
ethical person. That's why Ihave her on so much because I
work with a lot of, amazing VAattorneys, accredited claims
agents, VSOs, and I think theyall are wonderful and do so many
things for veterans. But, Imean, Rebecca is just top notch
(01:36):
when it comes to the way thatshe her brain works, the way
that she shows up for herclients, the way that she is
very responsive and and addsthat personal touch, I think, is
so wonderful. And that's why Ijust I've enjoyed getting to
know her over the years, and andI'm so glad that she's, so
willing to provide her insightsto you guys. So, hopefully, we
(01:58):
can convince her to get her ownchannel going here soon so you
guys can pour into her moreoften.
So I'm gonna keep nudging her onthat.
Rebecca Deming (02:06):
Leah, you're making me blush.
Leah Bucholz (02:07):
No. Well, I'm for real. So, before we before, I go
too off off topic, can you tellus what pyramiding is?
Essentially, what is thedefinition of pyramiding in the
context of VA disability? Sure.
Pyramiding is
Rebecca Deming (02:24):
basically VA's way of saying that you can't
double dip and get paid for thesame symptom under a different
diagnostic code. So if, youknow, if you've got three
different diagnoses That allimpact your ability to breathe
and they're all you've got COPD,asbestosis, sleep apnea and
(02:49):
asthma, they're all impactingyour respiratory function.
You're not going to get three orfour different ratings for that.
VA is going to say, okay, whichone's the highest one and we're
going to rate that one orthey'll kind of combine. I say,
combined with technically notthe right word, but they will
loop them under one code andgive you the highest rating
(03:11):
allowable under law for the oneof them.
Leah Bucholz (03:14):
Yeah, another one that I see a lot is just like
mental health conditions. Solike depression and anxiety.
There's a lot of overlap inthose symptoms. You may have
anxiety as a symptom of some ofyour depression also. They may
be distinct diagnoses in somecases, but sometimes those
things are subsumed in oneanother.
(03:35):
But again, we can Yeah,
Rebecca Deming (03:36):
for mental health it's always going to be
rated under the mental healthdiagnostic code. And we can get
into how TBI can sometimes bedifferent. But for mental health
it's always rated. So even ifyou have even if you're like,
I've got two very distinct, I'vegot my anxiety and when I've got
my anxiety, it makes me notsleep and I get nervous in
(04:00):
social settings and act out andI've got my depression, which
makes me sleep all day and twoseparate conditions that have
separate onsets and separate,you know, whatever face still
going to say, nope, those arepyramid. Those affect your
mental health and your abilityto function in your social and
occupational impairment.
And so because of the way thatthey rate them, you're not going
(04:21):
to get two separate disabilityratings for mental health.
Leah Bucholz (04:23):
Sure. So how does VA determine whether a person's
conditions are subject topyramiding?
Rebecca Deming (04:29):
So they, you know, the kind of overarching
answer is they're looking atwhether the same symptoms are in
the rating code or appear in twodifferent rating codes that. The
veteran would otherwise qualifyfor And then they're going to
give you the higher one of thetwo. They're not going to give
you both. The more nuancedanswer is there are very
(04:52):
specific guidelines in VA'srating schedule that will say,
you know, for this one, youcan't rate them both, choose the
one that most accurately orprovides the higher rating for
them. And so there are somewhere I always get sort of
(05:13):
surprised with the knee, You canget one rating for limitation of
flexion, one rating forlimitation of extension, and one
rating for instability.
And there's some nuance andthat's just because that's the
way the code is written. Soknowing those nuances can be
really helpful to maximizing therating for someone and also not
(05:35):
wasting your time if you're, youknow, like you said, if you've
got depression and anxiety, likethey're two different things and
you're spinning your wheelstrying to get a separate rating
and VA is like, we are nevergoing to give you a separate
rating for those two thingsbecause they all get rated under
the mental health code.
Leah Bucholz (05:48):
Yeah, or they might even say, hey, guess what?
You opened this claim foranxiety but you're rated for
depression and now we think thatyour depression has improved.
And it might not have, right?But just weird things can
happen. Anything can happen.
You got a new headache on yourhands, right? Yeah. So can you
explain the difference betweenseparate and overlapping
disabilities in terms ofpyramiding?
Rebecca Deming (06:09):
Sure, there can definitely be overlapping
disabilities and there's thingsthat are related. So you can
have, let's say you havediabetes and diabetes causes,
you get one rating for actuallyhaving diabetes and you get one
rating because you've gotneurogenic bowel or neurogenic
bladder and then one rating forthe peripheral neuropathy, and
(06:29):
it's all really related to yourdiabetes, but it's affecting
different body parts anddifferent systems. Then you're
going to get those separateratings for that. But with
pyramiding VA is looking at, isit impacting one body part, one
system, one function of that onesystem? So, it is sort of
(06:49):
nuance, like on your head, couldhave a scar on your face, you
could have headaches, you couldhave dry eye, you could have
rhinitis and you could have amouth issue, know, that's all in
your head, but those are goingbe separate issues because of
the way that VA says no, likeone's impacting your vision and
that's a separate function.
One's impacting your nose andrespiration. One's impacting
(07:13):
your ability to show up to work,because you're getting headaches
that are kind of knocking youout too often. So VA looks at
really not just they look atboth the body part, but also
what function is impaired. Andwhether they're separate
functions that are impaired. Sothey're looking at, can I give
you a separate rating for thisimpairment and this impairment
(07:33):
and this impairment?
Or is it really all all thesethree things are just impacting
your ability to move yourshoulder? And so, since you
can't move your shoulder, youget one rating for your
shoulder, whether it's caused byyour clavicle or your I'm not
even sure, Leah, what otherpieces in your Yeah. Yeah.
Leah Bucholz (07:56):
So there's your rotator another one, headaches.
I'm getting headaches. Well, Ihave tension headaches and I
have migraine headaches. Andthen I also have just
generalized headaches. Right?
They're all headaches. Right? Orwith the shoulder, it's
impacting your ability to move.So, like, I had a labral tear in
my shoulder. I had a rotatorcuff tear.
I had, AC joint issue. I had,like, five bajillion different
(08:18):
things wrong with the sameshoulder, but I'm not gonna get
I'm not actually even rated formy shoulder because it was
unrelated to service. But if Iwas, and if it was, then, you
know, it's gonna be one rating.
Rebecca Deming (08:32):
Right. Right?
Leah Bucholz (08:33):
So what are what are some of the potential
consequences for a veteran ifthe VA finds that their
disabilities are pyramided?
Rebecca Deming (08:41):
So you're only gonna get that one rating
whereas you're applying forseparate ratings. And so with
VA, it's sort of like a Tetrisgame or something, and you're
trying to fit all these piecestogether to get the highest
possible rating applying VAmath, which we did a separate
video on VA math. And so some,you know, if you were if you
(09:06):
were able to get four ratingsfor that shoulder, like, that
might. Move you from 70% to an80 or 90% or something,
depending on where what else youhad. Connected.
But because you only get thatone rating, you're going to be
stuck with that one rating. Sounderstanding that's just, I
mean, I think it's, there arecertain things that you can, can
(09:30):
do sometimes to differentiatesymptoms and be like, listen, I
qualify for the 70% under thisrating code without the symptoms
that would qualify under thatother rating code. So that
really should get two separateratings because they're, you
know, you can distinguish thesethings and they impact me in two
distinct ways. Then VA willseparate them. Do sometimes see
(09:55):
them combine things thatshouldn't be combined.
So, you know, sometimes we'llhave migraines with tinnitus or
something, and they give you onerating for migraines with
tinnitus. Under the currentrating schedule, like. You know,
and that is potentially subjectto change here soon. The
tinnitus or tinnitus should geta 10% rating if it's service
(10:18):
connected. And your migraineshould be rated based on how
frequently you're havingheadaches.
And so, even if they were bothcaused by. The TBI that you
suffered when you got hit in thehead and whatever they're two
separate things that should berated separately. So sometimes
when you see those things ratedtogether, you can separate them
out and get that extra. 10%,which may or may not impact your
(10:40):
combined rating. That's whyunderstanding the VA math is
really important to know whenit's worth putting in that extra
fight.
Leah Bucholz (10:47):
Yeah, I have a friend that's another VA
attorney. Have, and he was justmentioning to me the other day,
he's working on a case forsomeone that's got neck pain and
they tied in cervicogenicheadaches, right? So those, you
know, into the same And so thoseare just, yes, it is caused by
his cervical spine condition,but it is a separate like, as
(11:09):
you mentioned earlier about thediabetes, it can affect multiple
body systems. So you've gotheadaches caused by the neck.
That's a distinct separatecondition.
Right. That legal type he'sgonna have to make, I guess. So,
you know, along the same lines,how can what are some things
that a veteran can do to presenttheir case to avoid the pitfalls
(11:29):
of permitting?
Rebecca Deming (11:32):
So for some of them, you're just you're just
stuck. If the code's writtenthat way, you know, for the
longest time, and I think thishas been alleviated recently,
you know, you couldn't getseparate ratings for
gastroesophageal reflux disorderand IBS because they both have
that symptom of epigastricdistress or like the bloating
(11:54):
and pain in the stomach. And youknow, for me, one is exit and
one is entry. I think of youresophagus and your bowels as two
separate body parts, but VAbecause the symptoms were
overlapping. If that's the case,you can argue all day long, but
(12:18):
if the code is written that youcan't have separate ratings for
them, then you're stuck.
But on some of the more nuancedones, one of the ones that we
see a lot is TBI and PTSD,because if you got blown up and
(12:38):
that shook up your head, itmight also be the cause of some
post traumatic stress disorder.They could have the same origin,
but there's some overlappingsymptoms. So with TBIs, it's
really important to kind of lookat most of the time. I think you
don't and we could do a wholeseparate. We could probably do
(12:58):
multiple a whole series on TBIs.
Most of the time you're going tobe better rated if you get
instead of having a rating forTBI, you'd be better rated for
the individual symptomsunderneath. But sometimes you
can get a separate rating forPTSD because it's the emotional,
the cognitive behavioral changesthat are happening from PTSD,
(13:20):
but your TBI is really impactingbalance and memory and cognitive
function, which is separate fromthe PTSD. Especially if they're
separate injuries and so you cankind of say it's easier for the
doctors. And this is reallysomething there's medical
professionals that will get intoit and do some testing and
evaluations to say, no, no,these symptoms here are clearly
(13:44):
PTSD and on their own they meetthe criteria for a fifty or
seventy percent rating. And thenthese symptoms are very clearly
tied to the head injury and ontheir own they meet the criteria
for thirty, forty, seventypercent rating, whatever it is.
Then we can kind of argue thatVA should separate them out. I
(14:08):
think something that's reallyhard for veterans to do on their
own. It's hard for us as legalprofessionals to do working
closely with medicalprofessionals to separate some
of those out. So, if you findyourself in a situation where,
and I hate to say, hey, it'scomplicated, talk to a lawyer,
but this is one area that Ithink it's just going be really,
really challenging if you thinkthat VA incorrectly combined or
(14:33):
pyramided two ratings and youwant to try to separate them
out, you probably want to get anexpert to work with you, or a
couple experts, you know, thelegal professional and a medical
professional to help separatethat out.
Leah Bucholz (14:46):
So are there some specific conditions that come to
your mind like the most commonones that are prone to having
this happen?
Rebecca Deming (15:01):
Gastrointestinal ones are ones that, like I said,
the TBI and PTSD or mentalhealth and TBI often get
permitted. Respiratoryconditions very frequently get
permitted. So asthma, and thisone kind of boggles my mind, but
sleep apnea would get pyramidwith asthma or COPD or
(15:24):
asbestosis. So one is, you youhave know, sleep disturbed
breathing and you're waking upgasping for air at night and the
other is you have reduced lungcapacity during the day because
of these other impairments. Inmy opinion, they're kind of
separate, but VA has determinedthat they overlap enough because
they both impact respiratory andso you're only going to get
(15:45):
whichever one is higher.
So if you qualify for a thirtypercent for asthma and a fifty
percent for sleep apnea, you'rejust gonna get that one hundred
fifty percent for the sleepapnea and they'd probably write
it down as sleep apnea andasthma.
Leah Bucholz (16:00):
Can you share some of your insight on some examples
of some successful appealsrelated to pyramiding cases?
Rebecca Deming (16:12):
Sure, I mean I think it really comes back to
having the right medicalexperts. I mean sometimes
there's cases where VA just veryclearly misread the regulations
and they're peer rating stuffthat, like the tinnitus and the
migraines. There is nothing inthe migraine rating code that
(16:35):
mentions ringing in the ears sothe symptoms of. Tinnitus or
tinnitus are nowhere in therating code for migraine
headaches. So it's just notappropriate to say that it's
overlapping symptoms.
So that one, we probablywouldn't need a legal expert to
separate them out. We would justgo into the VA schedule for you
(16:56):
to disabilities, pull, and I'dprobably do a higher level
review initially. Might need toend up going to the board and
say, hey, because they don'toverlap, here's the rules and
regulations on pyramiding. Theseneed to be separated out and you
need a separate evaluation. I'dalso be looking at the C and P
exam to see what symptoms wereshown in there.
Leah Bucholz (17:21):
That example is one that would be pretty
straightforward if you did ahigher level review and you were
like, come on, like, we knowthat these two aren't combined,
but I guess common sense doesn'talways prevail. I would assume
that another rater would look atthat and say, oh yeah, clearly
this was a mistake and we needto separate these.
Rebecca Deming (17:39):
Right. Yeah, and so we have seen a few of those.
Luckily, I think that those arerare. I mean, there's not a
whole lot of times where they'rereading the. Under one code when
it's really multiple conditionsthat impact different body
(18:01):
systems or functions.
Think, yeah, the simple ones arepretty rare, but if you see
those where it's like, wait aminute, they rated you know, my
balance and my headaches is onecondition or something. That one
(18:23):
actually probably wouldn't bethat simple because you'd want
to be looking at, do you havevestibular migraines and are you
only losing balance at the timewhen you're having a migraine or
is one like, hey, I'm constantlyoff balance. And the other one
is, I have migraines that knockme out for a few hours at a
(18:44):
time.
Leah Bucholz (18:44):
Sure. So aside from accredited VA attorneys,
what are some other resources ofsupport or support that veterans
can access when they're dealingwith this?
Rebecca Deming (18:54):
I mean, you wanna get froggy, I like to pull
up the VA schedule of rateddisabilities and go right to the
source. And my favorite resourcefor that is the Cornell Law
website because of the way thatthey're written. I think it's
not paragraphs and paragraphs oflegalese. It kind of has the
(19:17):
hyperlinks or the condition, thecode, and then it's written in a
way that is pretty easy to findit and break it down. So you can
look at and be like, oh, okay,there is a, I mean, if you want
to read through that, you mightbe able to find the answer on
your own that.
Yeah, is never gonna give youseparate ratings for two
different mental healthdiagnoses or something. Or you
(19:41):
might look at it and say, Hey,ringing the ears is not a
symptom listed under the ratingcode for migraines, so why did
they combine those and not giveme two separate ratings?
Leah Bucholz (19:54):
So do you feel like there's a lot of
misconceptions that you hearregularly from veterans about
pyramiding that you have todispel?
Rebecca Deming (20:03):
I think the biggest one is that people just
think that every diagnosis thatthey have should be a separate
rating and not understandingthat VA is really looking. I
mean, I think in general, if youstep back, VA is looking at, at
least in theory, they're lookingat you as the whole person. And
so how do these differentdisabilities impact you? So if
(20:24):
you have one thing on your rightarm and one thing on your left
arm and one thing on your bowelsand one thing on your lungs,
that's going to impact youdifferently. If you have like
four different things on yourlungs, well, okay, we're just
looking at how those worktogether.
You might get a higher ratingbecause of the way that all
these things are impacting yourrespiratory function, but you're
(20:47):
only going to get the one ratingfor it. I think people just
assume that because they havemultiple diagnoses, they're
going to get a separate ratingfor every diagnosis that they
have.
Leah Bucholz (20:55):
How often do you actually see that VA incorrectly
pyramids things? I know we'vetalked a lot about like examples
of that, but how often do youthink this happens?
Rebecca Deming (21:05):
I mean, I think it's frequent enough that it's
worth having this this episodeand and talking about it, but I
don't think it's, like, all thetime. I you know, I I'd say it's
probably less than 5% thatthey're incorrectly permitting
stuff. You know, like one in 20where it should be separated and
(21:27):
they just sort of were like, oh,yeah, it's, you know, all from
the same injury and thereforeit's all one rating. You're
like, no, that's not what theregulations say. That's not what
the medical evidence shows.
They're really they should gettwo separate ratings. If I had a
number on it, I'd say one intwenty.
Leah Bucholz (21:44):
One in twenty of pyramiding cases
Rebecca Deming (21:48):
are that are inappropriately pyramided. Yeah.
Okay.
Leah Bucholz (21:51):
That's I mean, I I feel like that's a that's a good
enough it's not like you said,not that you see it every day,
but it's frequent enough thatit's annoying and people have to
deal with it semi regularly.
Rebecca Deming (22:05):
Yeah. I mean, I think that kind of brings up a
broader issue, not to go down awhole rabbit hole of the VA's
rating scheme in general isfairly complex. I mean, you can
access the schedule fordisabilities online and you can
read through it. But the nuancesof how to separate stuff out or
pyramid it or not pyramid it orwhen to pyramid it and how to,
(22:30):
you know, if you only claimdiabetes, but then the evidence
shows that you've got theseother tertiary conditions that
are caused by the diabetes thatVA should there's just there's a
lot of nuance and a lot ofobligations that's on VA, and
there's humans at differentlevels of government employee
that are applying these complexregulations. So there's a lot of
(22:53):
errors.
I think sometimes people willget a rating decision and
they'll be like, but why did VAdo this? And it's like, you
know, it's like asking whyyou're this is going to sound
insulting, but, you know, likeasking why your two year old is
tantruming. You know, theybecause it's, you know, because
they're two years old, becausebecause VA is a big bureaucracy,
(23:14):
they're going to make mistakes.Like, I wouldn't always ascribe
a rationale to it or think thatyou have to have a bigger fight
than you do. I mean, sometimesthe stuff that we need to fight
does require us to get a medicalexpert that's going to do
additional testing and reallydistinguish these two separate
conditions and how they impactthe veteran in very distinct
ways.
(23:34):
But sometimes it's just simpleVA error and
Leah Bucholz (23:40):
Yeah, unfortunately there's, like,
human process there. Right? Sothere's a human process, and
there's human bias. There'shuman mistake. There's human
whatever.
Right? So like any other, youknow, major bureaucracy
organization, whatever, there'sgonna be, unfortunately, things
(24:01):
that have to be fixed orrelooked at, etcetera.
Rebecca Deming (24:05):
Yeah. And if if it's a really simple, you know,
these two things should not bepermitted and you took the time
to look at the code and you feelcomfortable filing a higher
level review on your own. I knowwe usually talk about like, hey,
you know, if you're getting intoappeals, it's worth talking to
an accredited claims agent or anaccredited attorney. But
sometimes, you know, people wantto do stuff on their own and
(24:27):
they've done the research andthey just feel really confident.
You can write, you you do wantto write as much as possible.
You probably would want torequest an informal conference
with the Decision ReviewOfficer. But if it's really just
as simple as like VA, know, thisrating, I don't want say VA
didn't know what they weredoing, this rating officer who
wrote your decision didn't knowwhat they were doing. And you
(24:50):
can kind of pinpoint that forthe Decision Review Officer, you
might be able to get itoverturned in about four months
is what we're seeing higherlevel reviews take currently as
of April 2025 when we'refilming. Their timelines are
constantly shifting, but yeah,you might be able to overturn it
on your own by just kind ofpointing it out and following
(25:11):
that higher level review.
Leah Bucholz (25:13):
So I guess in your experience, how has the
interpretation of period of peermeeting evolved over time? And
then what trends do you thinkmay, you know, what is it going
to look like in the future? I
Rebecca Deming (25:33):
think that some of the more complex stuff might
be ripe to take on appeal allthe way up to the courts and
federal circuit if we need to,because VA has regular So, you
know, you've got the statutesand the regulations that apply
the statutes, and then you'vegot the way that the agency at
(25:54):
the lower level applies thoseregulations. And so sometimes I
think there's VA puts, theagency puts overly restrictive
interpretations of the rules onthere. So I think there are some
areas where, you know, couldreally push back as as legal
(26:15):
advocates and try to separateout the. Some of the things that
really are affecting veterans indifferent ways. I also think
that some of the testing for TBIhas gotten a lot more advanced
over the past few years, overthe past ten years.
(26:37):
In the past it would be like,Oh, we can only really determine
what the TBI did when we do abrain autopsy after you pass.
Now I think they're able to dokind of more imaging and more
testing and kind of separate outlike, okay, well this is really
a PTSD symptom and this isreally a TBI symptom. And then,
yeah, it's like logic puzzles,like, you know, you've got to
(27:03):
look at the rating code andespecially something as complex
as a rating code has multipledifferent. Places you're kind of
saying, you're looking at theirmedical records and saying they
have these symptoms documentedthat aligns with the, you know,
these sections of the ratingcode. So we're pulling these
pieces together and kind ofdiagramming it.
And if you love logic puzzles,then this is a good area to get
(27:28):
into and work on for yourself.If these things make your head
spin. Don't drive yourself crazyand hire someone to come in and
do the work for you and kind ofpull it apart and figure out
where what additional evidenceyou need.
Leah Bucholz (27:43):
Yeah, I'm interested to see what happens
and I'm sure we'll do somevideos on this here over the
next year about what's going tohappen with tinnitus and how
that's gonna get permitted andlumped in with other conditions.
And we won't go down that rabbithole, but that's gonna be one
that I think has a lot of talkhere coming up pretty soon. Then
(28:04):
also the sleep apnea and asthmachanges, which, know, again, we
can do some videos when thosethings come to fruition, think,
especially the tinnitus is gonnabe a big one for us to discuss.
Rebecca Deming (28:20):
Yeah, I mean, think sometimes these
regulations come into effect andthe changes get made and it
makes it easier for us to getcertain things separated out.
And then some of the regulationsthat are in the pipeline are
going to make it a lot morechallenging for veterans to get
adequately rated. And so peoplethat were easily getting 90 or
100 before, if they apply now,or if they apply after these new
(28:43):
regulations come into effect,are going to not get those
ratings or have to kind of thinkabout other body systems and
other claims that they mighthave in order to cover the same
ground.
Leah Bucholz (28:55):
Right. Well, that's pretty much I had, all
those the questions I had. Isthere anything that you can
think of that we missed that youthink is important to touch on
for pyramiding? Well, think
Rebecca Deming (29:09):
it's just a very fact specific situation, on
whether it's something that'ssimple misapplication of the
regulation or if it's, in yourcase, you've got very distinct
symptoms and talking to aprofessional and kind of working
through those things withsomeone who's had more
experience in pulling them apartis going to be helpful for most
(29:30):
people. And then, yeah, if youhaven't seen the video on VA
math, I think this video fitsreally well into that video in
terms of understanding. Causethere's times where you might
say, I really want to pick apartthe headaches from the tinnitus
and once it's only going to moveyou from 87% to eighty nine nine
(29:50):
percent, either way it's roundedup to ninety percent. And so
you're picking this big fightand you're not going to get any
back pay out of it anyway or anyadditional monthly compensation.
So if you haven't seen the videoon VA Math or the two videos on
VA Math, go back and watchthose.
Leah Bucholz (30:05):
Yeah, definitely check those out. And if you
would like to get in touch withRebecca at Pro Vet Legal, I'm
gonna put a link to her websitein the description of this
video. Or you can just go overto Pro Vet Legal, to her
website, it's provetlegal.com,right? Yes. And you can
certainly, know, have aconsultation with her and see if
(30:27):
maybe you guys would be a goodfit for one another.
Also, if you're looking for justlegal assistance in general,
your local VSO is always anoption that you can, especially
for new claims, you can always,reach out to those guys and and
they may be able to assist youas well. So as always, thank you
for hanging out with us today,Rebecca. And everybody please
(30:50):
drop some comments and like andsubscribe so that you can get
some more information. And letus know if there's any other
topics that you guys would liketo hear us talk about in the
future.
Rebecca Deming (31:01):
Awesome. Thank you for having me, Leah. Thank
you guys for watching. Alright.See you guys later.
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