Impairment evaluation based on the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition.
Typical impairment: 2% whole person impairment (WPI)
This is the overall average impairment rating value. There will be a range of impairments based on specific clinical data. If there is a difference of more than 3% whole person impairment (WPI) between the average observed corrected rating, it may be appropriate to evaluate that rating to determine if the rating is supportable.
Low back pain is a symptom, not a specific disease. Low back pain is discomfort in the lumbosacral area of the back that may or may not radiate to the legs, hips, and buttocks. A number of labels are commonly given to non-specific low back pain, including in the allopathic field “lumbosacral sprains and strains, and degenerative disc disease”, in the osteopathic field “somatic dysfunction” and in the chiropractic field “subluxations”.
It is recognized however that the finding of degenerative changes in the spine are commonly seen among asymptomatic individuals as they age. In this case a specific etiology for the back pain is not evident. The treatment for non-specific low back pain is best supportive and functional in nature, e.g. focusing on flexibility, strengthening and conditioning.
Unnecessary diagnostic and therapeutic interventions, particularly those that are invasive, are to be avoided. Unnecessary rest and involvement in passive modalities may result in deconditioning and dysfunctional behavior.
Impairment evaluation is based on the AMA Guides to the Evaluation of Permanent Impairment. An accurate, unbiased rating is based on accurate clinical data (e.g., history, physical examination, imaging studies, other studies and diagnosis) and following the process established in the AMA Guides. The AMA Guides provide directives in Sections, dependent upon the diagnosis, using specific criteria. Guidance on the rating process is provided below and the specifics specified in the AMA Guides must be followed. In reviewing impairment ratings, it is appropriate to make sure that the ratings are error free. Independent medical evaluations should conform to published best practices.
Section 17.2 Diagnosis-Based Impairment (560-566), Section 17.3 Adjustment Grids and Grade Modifiers: Non-Key Factors (566-592)
Table 17-4 Lumbar Spine Regional Grid: Spine Impairments (570-573), Table 17-5 Adjustment Grid: Summary (575), Table 17-6 Functional History Adjustment: Spine (575), Table 17-7 Physical Examination Adjustment: Spine (576), Table 17-9 Clinical Studies Adjustment: Spine (581)
Accurately define diagnosis, including significance and consistency of clinical findings, presence of causally-related disk herniation(s), and/or alteration of motion segment integrity. Objectify the presence or absence of radiculopathy. Most ratings are for non-specific spinal pain. Need to discern if Class 0 or Class 1 assignment. Maximum impairment for Class 1 is 3% WPI. Assure accuracy of adjustment factors, net adjustment calculation, and grade modification. Figure 17-2 (561) summarizes findings.
Inaccurate clinical assessment resulting in wrong Class assignment. Rating for more than diagnosis in region. Unreliable functional history, physical examination findings or clinical studies. Adjusting for physical examination or clinical studies findings when same information used for Class assignment.
Impairment evaluation must be performed in accordance with the standards provided in AMA Guides to the Evaluation of Permanent Impairment and independent medical evaluations should conform to published best practices.