The American Medical Association Guides to the Evaluation of Permanent Impairment (4th Edition) are used by California workers’ compensation physicians to describe residual impairment from an industrial injury.
When an injured worker sustains an injury to the spine, whether it be to the neck (cervical spine), mid back (thoracic spine) or lower back (lumbar spine), evaluating physicians who are outlining an individual’s permanent disability are likely going to try and use either of two methods to rate the impairment.
Diagnosis-Related Estimate vs. Range of Motion Method
The AMA Guides provide the DRE, or diagnosis-related estimate, is considered to be the primary methodology used to evaluate an individual who has a distinct injury. The Guides provides five (5) categories under the DRE depending on the extent of the injury. For instance, an injury may be considered category 1 if an incident leads to spine complaints that are less than significant, or otherwise no muscle guarding/spasm, no documented neurological loss, no documented loss of spine structural integrity. Whereas an injury can be considered category 5 when significant guarding/spasm is documented, radiculopathy is verified by testing, a herniated disc has been objectively identified, a fracture, and there is significant extremity impairment to the corresponding spinal region.
Depending on the particular category used by the evaluating physician, the doctor will have a range of values to use to describe the permanent impairment. Category 1 with no significant complaints carries a 0% whole person impairment. A more significant injury described under Category 5 can range between 25%-28% whole person impairment.
The DRE Method
The DRE method is criticized as it does not allow the evaluating physician a great deal of latitude in outlining the permanent impairment for a particular spine injury. Moreover, when a proper category has been identified under the DRE, the doctor has a small range of values to use to accurately describe the impairment.
The ROM Method
The ROM, or range of motion method, is to be used when the DRE method does not apply, or an individual cannot be easily categorized by the DRE. ROM is also used when there is multilevel disc involvement, or alteration of motion segment integrity (a fusion surgery). The ROM, when utilized correctly, can help an evaluating physician most comprehensively describe an individual’s permanent impairment as it takes into account range of motion loss of the impaired spine region and considers any accompanying diagnosis and spinal nerve deficit.
Generally, where the ROM method can be used it will result in a higher permanent impairment value and therefore a higher permanent disability amount from the workers’ compensation injury. Thus, where it can be used it is favored for the evaluation of injured workers. It is important to note that where both DRE and ROM can be used, the higher value is to be adopted by the evaluating physician to describe impairment.
Because of the level of specialization involved with evaluating permanent disability within the AMA Guides, especially when evaluating spinal injuries whether it be via DRE or ROM methods, an injured worker may want to consult with an attorney to review whether a doctor has most accurately described permanent residuals from an injury.
Gerald Brody Law Firm is the Workers' Compensation Experts
The attorneys at Gerald D. Brody & Associates deal with DRE and ROM issues within the AMA Guides on a regular basis with their clients who have sustained spinal injuries and are proficient in challenging physician ratings and obtaining a higher impairment value. We will not hesitate to request additional medical reports from doctors or take the doctor’s deposition to make them aware of alternative ways to rate an injury under CA workers’ compensation law.