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I just completed c&p exam for my bilateral hips after replacement September 30. I had another c&p exams  for psoas tightness after hip replacement (secondary) I was wondering would this be pyramiding because psoas controls hip flexion, but I told examiner that it's my lower back that hurts the most because of psoas tightness. 

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38CFR4.14   Avoidance of pyramiding.

The evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. Dyspnea, tachycardia, nervousness, fatigability, etc., may result from many causes; some may be service connected, others, not. Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation, and the evaluation of the same manifestation under different diagnoses are to be avoided.

From cck-law.com

Pyramiding: How to avoid stacking your VA ratings


Pyramiding is the VA term for rating the same disability – or same manifestation (i.e. symptom) of a disability – twice. The term comes from a federal law – “Avoidance of pyramiding” – that prohibits the practice in VA disability claims.

The rule sounds simple enough, but disabilities can manifest in unusual ways. A veteran’s symptoms may not always line up with the set of symptoms VA lists for each diagnosis in their rating guide, the VA Rating Schedule. A veteran might experience the same, or overlapping, symptoms as a result of two separate conditions. This is particularly true for veterans with multiple diagnoses of particular types of conditions – like mental health conditions or respiratory conditions – because symptoms from these groups so frequently overlap. Continue Reading on cck-law.com

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