If a worker in Texas suffers an injury to their neck or back and receives a Impairment Rating which includes a DRE Category IV, it will be for “Loss of Motion Segment Integrity or Multiple Neurologic Compromise.”
Loss of Motion Segment Integrity: Translation of one vertebra on another segment that is 11 degrees more that the angular motion at an adjacent motion segment; along with documented history of muscle guarding and pain.
Multiple Neurologic Compromise: There must be bilateral radiculopathy or radiculopathy at multiple levels per the requirements of a DRE Category III. This must include a documented history of muscle guarding and pain.
If a claimant receives a DRE Category IV for a cervical injury, they will receive a 25% whole body impairment rating for that condition. If the claimant receives a DRE Category IV for a thoracic or a lumbar injury, they will receive a 20% whole body impairment rating for that condition.
The Morris Law Firm, email@example.com (214)357-1782
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
Texas uses the Fourth Edition of the American Medical Association Guides to the Evaluation of Permanent Impairment to determine Impairment Ratings for injured workers. The Guide is to only apply to permanent impairments, defined as adverse conditions that are stable and unlikely to change.
The Guides require that a doctor performing an evaluation must first gather through and complete historical information on the medical condition(s) and then carry out a medical evaluation supported by appropriate tests and diagnostic procedures.
The doctor should determine the condition that seems to be of the most concern to the injured worker. That condition needs to be assessed and given a whole body impairment. Each of the unrelated conditions must be assessed and given a whole body impairment. Then all the conditions are combined using the Combined Values Chart.
The Guides find the impairment by DREs (Diagnosis Related Estimates), ROM (Range of Motion) and specific Diagnosis ratings. The Guides determine if the methods are combined or one method is to be used with the exclusion of the others.
The Morris Firm, firstname.lastname@example.org, (214)357-1782
One of the biggest issues with the Texas Workers’ Compensation system is confirming that the injured worker gets a fair date of Maximum Medical Improvement (MMI) and Impairment Rating (IR). Once a worker is found to be at Maximum Medical Improvement, they are not eligible to receive Temporary Income Benefits (TIBs).
If the worker has not been examined by a designated doctor, the certification may be disputed by filling out a DWC-32 form requesting a designated doctor to determine MMI and IR. If the injured worker has previously been examined by a designated doctor for MMI and IR, a DWC-45 form must be turned in to the Division of Workers’ Compensation to request a Benefit Review Conference.
Disputes over the certification are very time sensitive. A certification must be disputed within 90 of receipt by verifiable means. There are three statutory exceptions to this rule. So, if you have not disputed your certification within 90 days, consult with an attorney who practices workers’ compensation.
Daniel L Morris, The Morris Law Firm, email@example.com, (214)357-1782
Under the Texas Workers’ Compensation system, a worker will reach Maximum Medical Improvement when based on reasonable medical probability, further material recovery from or lasting improvement to an injury can no longer reasonably be anticipated. Generally this must happen no later than 104 weeks from the date that benefits begin to accrue.
Texas currently uses the 4th Edition of the Guides to the Evaluation of Permanent Impairment. The Guides provide the manner for a doctor to calculate the injured workers’ Impairment Rating. The rating will will be no impairment or a finding from 0% to 100% whole body impairment rating.
To do a proper rating, the doctor must address each compensable condition and provide a rating for that condition. All conditions are added to provide the whole body impairment rating.
Daniel L. Morris, The Morris Law Firm, http://www.themorrisfirm.net, (214)357-1782