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Would This Be Pyramiding?


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Question

Pyramiding:

Pyramiding is the prohibition of assigning more than one evaluation per bodily etiology based on the same symptoms. CFR 38, §4.14 states;

Here are the two nerve issues that I have and their rating schedules. One symptom is pain shooting down the legs (Sciatic Nerve) The other symptom is my legs giving out, I think this is related to the tibial nerve. Would both apply since they have different symptoms?

Sciatic nerve

8520 Paralysis of:

Complete; the foot dangles and drops, no active movement 80

possible of muscles below the knee, flexion of knee weakened

or (very rarely) lost.......................................

Incomplete:

Severe, with marked muscular atrophy....................... 60

Moderately severe.......................................... 40

Moderate................................................... 20

Mild....................................................... 10

Internal popliteal nerve (tibial)

8524 Paralysis of:

Complete; plantar flexion lost, frank adduction of foot impossible, flexion and separation of toes abolished; no muscle in sole can move; in lesions of the nerve high in popliteal fossa, plantar flexion of foot is lost 40

Incomplete:

Severe 30

Moderate 20

Mild 10

Thanks Paul

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  • HadIt.com Elder

that would not be pyramiding, since there are two seperate nerves affected, and each has different symptoms. I would, however, get a good diagnosis from a neuro doc. I have very severe sciatica, and I have the pain that shoots down my hips and legs, but it also makes my legs become completely useless on many days. You may only be suffering from sciatica.

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I suspect you only have siatiac nerve damage. The only way to be sure what is going on is to have a nerve conductive studies completed. In fact you will need one done before the va would rate you for any nerve damage anyway. As you PC doctor for a referal, the test is rather painless, and only takes about 30 minutes... just don't look at the needle that they stick in you buttocks and you will be fine.....

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  • HadIt.com Elder
In fact you will need one done before the va would rate you for any nerve damage anyway.

That's not true. The rating criteria for the spine allows for neurologic and orthopedic manifestations to be rated with the single exam. I was rated for a neurogenic bladder without having a exam specifically for it. In addition to that, a nerve conduction study/EMG is a painful, invasive test that far too often gives poor results in spine patients due to muscle guarding. Muscle tension in the lower back blocks the testing signal from getting to the target nerve, so the doc isn't able to tell the extent of the damage.

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That's not true. The rating criteria for the spine allows for neurologic and orthopedic manifestations to be rated with the single exam. I was rated for a neurogenic bladder without having a exam specifically for it. In addition to that, a nerve conduction study/EMG is a painful, invasive test that far too often gives poor results in spine patients due to muscle guarding. Muscle tension in the lower back blocks the testing signal from getting to the target nerve, so the doc isn't able to tell the extent of the damage.

I have had an EMG, the results were that the doc found one connection to L-5 S-1, but he said he did not find others, which would be conclusive evidence that their was damage. He said he would enter it in the report, but what he entered in the report was, "There was a non specific finding observed in one muscle, that was non reproduced in other similarly innervated muscles."

I agree that muscle tension blocked the signal. This test was very invasive and I had nerve twitching for several weeks after the test.

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