FOLIO

AP Clarifies How to Properly Rate the Thoracic Spine under DRE

Nov 9, 2022 | by FOL

In APD 221500, filed September 28, 2022, the AP clarified assessment of the thoracic spine under the Diagnosis-Related Estimate (DRE) methodology.

The parties stipulated that the compensable injury extended to, in part, a thoracic sprain/strain, and the AP affirmed the ALJ’s determination that the compensable injury also extended to a herniated nucleus pulposus at T5-6 and herniated nucleus pulposus at T7-8 with cord compression.

The ALJ adopted the 40% impairment rating assigned by Dr. M. However, Dr. M assigned 40% impairment by placing the claimant in DRE Cervicothoracic Category V.

In APD 051306-s, decided August 3, 2005, the AP discussed the application of the AMA Guides in rating cervical, thoracic, and lumbar injuries and held as follows, based on the language from the bottom of page 3/95 of the AMA Guides.  If the injury is primarily to the cervical spine the rating would be under cervicothoracic spine impairment; if the injury was primarily to the thoracic area of the spine the rating would be under thoracolumbar spine impairment; and if the injury is primarily to the lumbar portion of the spine, the impairment would be under lumbosacral spine impairment.

Parenthetically, the AP also held that if more than one spine region is impaired, the doctor is to determine the impairment of the other regions and combine the regional impairments using the Combined Values Chart to express the claimant’s total spine impairment.

In the present case, the AP held that because the compensable injury was primarily to the thoracic area of the spine, yet Dr. M assigned 40% impairment by placing the claimant in DRE Cervicothoracic Category VI, Dr. M did not rate the compensable injury in this case in accordance with the AMA Guides.

As there was no other IR in the record that properly included the entire compensable injury, the AP reversed and remanded the ALJ’s findings that the impairment rating was 40%, as assessed by Dr. M, with instructions to send the claimant back to the designated doctor.