By Dr. Christopher Brigham
A frequent area of confusion when rating the spine is determining which method, Diagnosis-Related Estimates (DRE) or Range-of-Motion (ROM), is applicable to a case. This week's tip will review the Guides criteria and provide examples of proper interpretation of these guidelines.
* The principal methodology used for distinct injuries.
* Most injuries are attributed to a specific event. In these cases, DRE is applicable unless other factors are present that will be discussed in ROM.
* Reported "cumulative trauma" injuries to the spine are rated via the DRE method unless there are specific indications (discussed below) to rate via ROM. (Injuries defined as "cumulative trauma" require thoughtful causation and apportionment analysis to determine the true etiology, i.e. significant multiple injuries versus degenerative disease associated with aging or genetics.)
* When rating for a corticospinal tract injury.
* These cases require rating for corticospinal tract injury and then combining with the appropriate DRE category regardless if there was multilevel involvement or recurrent radiculopathy.
* If the cause of an injury is not determined but the injury can be well characterized by the DRE method.
* An example is an individual with multi-level degenerative disc disease and gradual onset of lower back pain with verified single level, unilateral radiculopathy.
* Multilevel fractures or multilevel radiculopathy in the same spinal region.
* An example is multiple compression fractures in the lumbar spine. If there is a single level fracture in the lumbar spine and a single level fracture in the cervical spine, the DRE method would be applied since they are not in the same spinal region.
* Bilateral radiculopathy in the same level in the same spinal region.
* A bilateral radiculopathy at a single level would be rated via the ROM method.
* When there has been a recurrent radiculopathy, either due to disk herniation or stenosis in the same spinal region.
* A recurrent "sprain" without radiculopathy would not qualify for the ROM method.
* Multilevel motion segment alteration such as fusion or translational movement as defined in the Guides.
* A single level fusion, in most cases, would be rated via DRE method whereas a multilevel fusion would be rated via ROM.
* Multiple, recurrent episodes of other pathology producing an alteration of motion segment integrity and/or radiculopathy in the same spinal region.
* When statutorily mandated.
It is possible for different spinal regions to be rated, in the same case, by different methods. In these cases, the impairment from each method is combined for final whole person impairment. (In California workers' compensation cases regional impairments are adjusted and the resultant permanent disability ratings are combined.)
Brigham is the editor of the Guides Newsletter and Guides Casebook. To view more of these tips visit: www.impairment.com/tips
The views and opinions expressed by the author are not necessarily those of workcompcentral.com, its editors or management.