Criteria: Box 15-1 (382), Table 15-3 (384)
Guidance: Principles of assessment defined in Section 15.1 (374 – 379) must be followed. Most ratings are based on the Diagnosis-Related Estimates (DRE) approach; therefore assure appropriate DRE Categorization and placement within range. Range of Motion (ROM) method is used in certain circumstances, such as multilevel radiculopathy or multilevel fusion (not used for common findings of multilevel degenerative disease); if ROM used assure that usage is applicable and verify components with particular reference to reliability and rating of motion deficits. The Fifth Edition states in Section 15.2, Determining the Appropriate Method for Assessment (379) – “The DRE method is the principal methodology used to evaluate an individual who has had a distinct injury.”(379). Section 15.3, Diagnosis-Related Estimates Method (p 381-384), explains the process used to obtain the rating – “To use the DRE method, obtain an individual’s history, examine the individual, review the results of appropriate diagnostic studies, and place the individual in the appropriate category…almost all individuals will fall into one of the first three DRE categories. Altered motion segment integrity (i.e., increased motion or loss of motion) qualifies the individual for category IV or V. In most cases, using the definitions provided in Box 15-1, the physician can assign an individual to DRE category I, II, or III. An individual in category I has only subjective findings. In category II, the individual has objective findings but no radiculopathy or alteration of structural integrity, while in category III, radiculopathy with objective verification must be present. Since an individual is evaluated after having reached maximal medical improvement (MMI), a previous history of objective findings may not define the current, ratable condition but is important in determining the course and whether MMI has been reached. The impairment rating is based on the condition once MMI is reached, not on prior symptoms or signs.” Box 15-1, Definition of Clinical Findings Used to Place an Individual in a DRE Category (382), specifies the clinical findings used in a DRE model classification. The rating of a Lumbar (low back) injury is performed according to Section 15.4, DRE: Lumbar Spine (384-388), and with Table 15-3, Criteria for Rating Impairment Due to Lumbar Disorders (384). If subjective complaints are not supported by significant ratable objective findings the individual is assigned to DRE Lumbar Category I and there is no impairment. If there is ratable impairment, the most common classification is DRE Lumbar Category II and 5% to 8% whole person permanent impairment. The criteria for this placement is “Clinical history and examination findings are compatible with a specific injury; findings may include muscle guarding or spasm observed at the time of the examination by a physician, asymmetric loss of range of motion or nonverifiable radicular complaints, defined as complaints of radicular pain without objective findings; no alteration of the structural integrity.” This placement also occurs if there was a history of clinically significant radiculopathy that has resolved when at maximal medical improvement. Significant objective findings of single level Lumbar radiculopathy result in DRE Category III rating of 10% to 13% whole person permanent impairment. Alteration of motion segment integrity, most often due to a surgical fusion, results in DRE Lumbar Category IV rating of 20% to 23% whole person permanent impairment. Most ratings are provided at the lower range, unless there is documentation of significant interference with activities of daily living (ADLs). The process of rating using the Range of Motion method is discussed in Section 15.8 (398-404) and for the Lumbar spine in Section 15.9 ROM Lumbar Spine (405-411). This impairment is based on the combined impairment for a specific spine disorder, motion deficits (if any) and neurological deficits (if any). The impairment for a specific diagnosis is determined from Table 15-7, Criteria for Rating Whole Person Impairment Percent Due to Specific Spine Disorders to Be Used as Part of the ROM Method (404). Figure 15-10 (410) Lumbar Range of Motion (ROM) reports motion findings and impairments are based on Table 15-8 Impairment Due to Abnormal Motion of the Lumbar Region: Flexion and Extension (407) and Table 15-9 Impairment Due to Abnormal Motion of the Lumbar Region: Lateral Bending (409). If there are neurological deficits, these are assed using Table 15-18 Unilateral Spinal Nerve Root Impairment Affecting the Lower Extremity (424), Table 15-15 Determining Impairment Due to Sensory Loss (424), and Table 15-16 Determining Impairment Due to Loss of Power and Motor Deficits (424). The neurological impairments are combined and converted to whole person permanent impairment using Table 17-3 (527). The combined whole person impairment is based on the impairment for specific disorders, motion deficits, and neurologic deficits.
