Can VA Give Me Two Ratings for the Same Injury?

VA can give you two ratings from the same injury if they are for different disabilities or different symptoms. What VA can't do is rate the same symptom twice under two diagnoses; that is called pyramiding, and 38 CFR 4.14 forbids it. But one injury or disease can cause several separate disabilities, and 38 CFR 4.25(b) says those are rated separately and then combined. A back injury with nerve problems in the leg, for example, can be rated for the spine plus a separate rating for the nerve.

The question VA asks is not "how many ratings came from one injury?" It is "does each rating pay for something the others don't?"

What is pyramiding?

Pyramiding is rating the same disability, or the same symptom, more than once under different diagnoses. 38 CFR 4.14 says the evaluation of the same disability under various diagnoses is to be avoided, and so is the evaluation of the same manifestation (symptom) under different diagnoses. It also bars using symptoms that don't come from a service-connected condition to raise a service-connected rating.

The regulation names the areas where overlap is most common: injuries to the muscles, nerves and joints of an arm or leg can overlap a great deal, so each body system has its own special rules for rating them. Symptoms like shortness of breath, fast heart rate, nervousness and fatigue can come from many causes, some service-connected and some not.

When one injury can get two or more ratings

38 CFR 4.25(b) says disabilities arising from a single disease entity (it gives arthritis, multiple sclerosis and stroke as examples) are rated separately, and then all the ratings are combined. Unless the rating schedule says otherwise, each distinct disability gets its own rating. Two examples written into the schedule:

• Back conditions and nerves. The general rating formula for the spine (38 CFR 4.71a, Note (1)) tells VA to rate any associated objective neurologic abnormalities separately, including bowel or bladder problems. Nerve problems in a leg from a back condition can get their own rating under a nerve diagnostic code, on top of the spine rating.
• Tinnitus and hearing loss. The note to diagnostic code 6260 in 38 CFR 4.87 says a separate rating for tinnitus can be combined with a hearing loss rating, except when the tinnitus supports the rating under that other code. See hearing loss ratings.

How to tell if a symptom was folded into another rating

Your decision letter lists each service-connected condition with its rating, and the rating decision names the diagnostic code. Line those up against your symptoms:

1. 1List the symptoms you actually have from the injury or disease, such as pain and limited motion, numbness or weakness in a leg, bladder problems, or ringing in the ears.
2. 2For each symptom, find the rating that pays for it. The criteria for that diagnostic code show what it covers; the rating criteria pages have the ladders.
3. 3A symptom that no rating's criteria cover, and that has its own diagnostic code, may be ratable separately. A symptom already counted in one rating's criteria can't be counted again.

If a separate symptom was never claimed, file a claim for it. If VA had the evidence and still left it out, you generally have one year from the decision to ask for a Higher-Level Review or another review lane; the appeal options guide explains how to choose. A free VA-accredited VSO can check the letter with you.

Frequently asked questions

What is pyramiding in VA ratings?

Rating the same disability or the same symptom more than once under different diagnoses. 38 CFR 4.14 says VA must avoid it. It doesn't stop VA from giving separate ratings for separate disabilities that come from the same injury.

Can I get a separate rating for nerve pain from my back condition?

It can be rated separately. The spine rating formula (38 CFR 4.71a, Note (1)) tells VA to rate associated objective neurologic abnormalities, such as nerve problems in a leg or bladder problems, separately under the right diagnostic code. The nerve problem has to be documented, for example on exam or in testing.

Are tinnitus and hearing loss rated separately?

Usually, yes. The note to diagnostic code 6260 (38 CFR 4.87) says a tinnitus rating can be combined with a hearing loss rating, except when the tinnitus supports the rating under the other code.

Does one injury mean only one rating?

No. 38 CFR 4.25(b) says disabilities arising from a single disease entity are rated separately and then combined. The limit is that each rating has to pay for something different.

What should I do if VA folded a symptom into another rating?

Check whether that symptom is covered by the criteria of the rating you have. If it isn't, and it has its own diagnostic code, raise it: a new claim if it was never claimed, or a review within one year of the decision if VA had the evidence and left it out.