Rating the Effects of Whiplash

Saturday, July 28, 2007 | 0

By Dr. Christopher R. Brigham

Whiplash-associated disorder (WAD) is often challenging.

Neck pain following motor vehicle collisions is common, but there is significant variation in the duration of symptoms. Research suggests chronic whiplash symptoms should be the exception rather than the rule; and most cases of WAD resolve without permanent impairment. Many factors influence the development of chronic whiplash symptoms including preexisting pathology (physical and/or psychological), the severity of the injury, individuals' expectations of pain and disability following a collision, cultural influences, and psychosocial stressors.

Our review of automobile casualty cases reveals that litigation, cultural, psychological, and sociological influences contribute to an epidemic of chronic whiplash symptoms in the United States; this is also consistent with the medical literature. In Florida we have found that the vast majority of the impairment ratings have in reality no objective basis to support permanent impairment. The typical troublesome case is an individual involved in a minor motor vehicle accident, who receives extensive passive modalities and testing, and who is rated by the treating physician within four months of the injury as having substantial impairment.

Permanent impairment cannot be assessed until the individual is at maximal medical improvement (MMI). Therefore it is essential to determine whether appropriate treatment has been provided. Many of the treatments provided for WAD are of questionable efficacy, and not necessary to achieve MMI.

Impairment rating is based on clinical data obtained when at MMI. Parties involved in a claim or lawsuit often want to settle as soon as possible. However, only permanent impairment should be rated. Recovery occurs in four to six weeks in most uncomplicated WAD cases. However, for others maximal improvement in symptoms and physical findings such as cervical guarding and motions may take a year from the date of injury. Surgery or intervening injury, exacerbation, or aggravation may delay MMI further.

Impairment assessment for WAD is performed using Chapter 15, The Spine, and must follow the Principles of Assessment in Section 15.1 (5th ed, 374 - 379). The Diagnosis-Related Estimates (DRE) Method is nearly always used to rate WAD since the impairment is attributed to a distinct injury. Most cases of WAD result in a DRE Cervical Category I or II (0% or 5-8% WPI, respectively).

Common ratings errors include: assessing impairment prior to MMI, basing the rating on unreliable or inconsistent findings, selecting DRE Cervical Category III based on subjective radicular complaints without objective evidence of radiculopathy, assigning DRE Cervical Category IV on the basis of questionable radiographic studies, use of the Range of Motion (ROM) Method, and including rating of regions of the spine or body not causally related. Often the incorrect rationale for the use of the ROM Method is multilevel degenerative disk disease and/or degenerative arthritis. These common age- related findings do not just justify use of the ROM method. Ratings of WAD performed by treating physicians are more likely to be erroneous since they by definition are not independent and they may be less familiar with the appropriate use of the Guides.

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.