When a Worker in Texas has a neck or back injury that is being handled through the Division of Workers’ Compensation, they will receive a Whole Body Impairment Rating. To determine that Impairment Rating, the medical provider will typically use a DRE Category (Diagnosis Related Estimate) that best suits the claimant’s (injured worker) condition.
To avoid a DRE Category I, which means no impairment at all, there must be clinical findings of injury, observed or documented muscle guarding or documented neurological impairment.
Many cases deal with the observed or documented muscle guarding. The Fourth Ed. of the AMA Guides to Permanent Impairment define Guarding under Table 71 Pg. 3/109 of the Guides as: paravertebral muscle guarding or spasm or nonuniform loss of range of motion, dysmetria, is present or has been documented by a physician. Radicular components that follow anatomic pathways but cannot be verified by neurologic findings belong with this type of differentiator.
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Spinal injuries for cervical, thoracic and lumbar which in radiculopathy may be eligible for a DRE Category III. Radiculopathy is a condition due to a compressed nerve in the spine that can cause pain, numbness, tingling, or weakness along the course of the nerve.
To qualify a person must have an ongoing minor neurologic impairment low the lower extremity related to cervical, thoracic or lumbar injury. This is documented through examination of reflexes and findings of unilateral atrophy above or below the knee related to no other condition, and it may be verified by electrodiagnostic testing. The injured worker must have one of the two following findings:
- Decreased circumference (atrophy) Spine-injury-related circumferential measurements show loss of girth of 2 cm or more above or below the elbow or knee. The atrophy cannot be explained by non-spine-related problems or contralateral sypertrophy, as might occur with a dominatnt limb or greatly increased use of a limb. The neurologic impairment may be verified by differentiator 4 below.
2. Electrodiagnostic evidence Unequivocal electrodiagnostic evidence exists of acute nerve root compromise, such as multiple positive sharp waves or fibrillation potentials; or H-wave absence or delay greater than 3 mm/sec; or chronic changes such as polyphasic waves in peripheral muscles.
If a person receives a DRE Category III, that is equal to a 15% Impairment Rating for the Cervical spine and a 10% Impairment Rating for the Thoracic or Lumbar spine.
As explained last time, Texas Workers’ Compensation neck and back injuries that receive a DRE category I for impairment are considered to have no impairment at all. The DRE category II is for minor impairments to the neck or back.
To qualify for a DRE category II, the injured worker should have a clinical history and examination findings that are compatible with a specific injury or illness. The findings may include significant intermittent or continuous muscle guarding that has been observed and documented by a physician, non-uniform loss of range of motion, or nonverifiable radicular complaints. There is no objective sign of radiculopathy and no loss of structural integrity.
Under the Texas Workers’ Compensation system, a DRE category II entitles an injured worker to a 5% whole body impairment. This translates to 15 weeks of impairment income benefits.
Morris Law Firm, (214)357-1782, email at firstname.lastname@example.org.
We have seen a dramatic decrease from designated doctors impairment ratings for sprain/strain spinal injuries in Texas Workers Compensation claims. The Fourth Edition of the AMA Guides generally uses Diagnosis Related Estimate (DRE) Categories to provide for spinal injuries. Most sprain/strain injuries result in either a DRE Category I or a DRE Category II.
To find a DRE Category I, it must fit under the following description and verification:
The patient has no significant clinical findings, no muscle guarding or history of guarding, no documentable neurologic impairment, no significant loss of structural integrity on lateral flexion and extension roentgenograms, and no indication of impairment related to injury or illness.
A DRE Category I provides a 0% Impairment Rating. This essentially means that the injured worker has no permanent impairment as a result of the compensable injury.
Daniel L Morris, The Morris Law Firm, email@example.com, 9214)357-1782