AP Explains how to Calculate IR for Distal Clavicle Resections
The appeals panel has issued a decision that holds that impairment for a distal clavicle resection arthroplasty that was received as treatment for the compensable injury results in 10% UE impairment under Table 27, which is then combined with ROM impairment. The appeals panel posted its decision in Appeals Panel Decision 151158-s on August 19, 2015.
The claimant injured his left shoulder while repeatedly lifting a 200-pound gate and operated a pallet jack. The carrier accepted as part of the compensable injury a left shoulder sprain/strain, left shoulder anterior labral tear, left shoulder partial detachment of the anteroinferior labrum and left shoulder partial detachment of the posterior horn. Before he reached MMI, the claimant underwent a distal clavicle resection arthroplasty for the compensable injury.
Two doctors examined the claimant and offered impairment ratings: the treating doctor and the designated doctor. Both doctors assigned permanent impairment for lost range of motion. The two doctors differed, however, in whether to include 10 percent UE impairment to the ROM impairment based on the distal clavicle resection arthroplasty. The hearing officer adopted the rating that combined the ROM with 10 percent upper extremity impairment and rejected the rating that was based solely on lost ROM. The carrier appealed.
The appeals panel affirmed the hearing officer’s adoption of the combined impairment rating.
The question in this case is whether a distal clavicle resection arthroplasty received as treatment for the compensable injury results in a 10% UE impairment under Table 27 of the AMA Guides.
The AMA Guides provide on page 3/58 the following:
It is emphasized that impairments from the disorders considered in this section [3.1m Impairment Due to Other Disorders of the UE] are usually estimated by using other criteria. The criteria described in this section should be used only when the other criteria have not adequately encompassed the extent of the impairments.
Table 27, Impairment of the UE After Arthroplasty of Specific Bones or Joints, falls under Section 3.1m. When considering the language on page 3/58 in isolation it would appear that a distal clavicle resection arthroplasty would receive a 10% UE rating under Table 27 only if the other criteria provided in the AMA Guides have not adequately rated the impairment. However, the AMA Guides also provide on page 3/62 the following specifically regarding arthroplasty of a joint:
In the presence of decreased motion, motion impairments are derived separately (Sections 3.1f through 3.1j) and combined with arthroplasty impairments using the Combined Values Chart (p. 322).
The language on page 3/62 clearly provides that impairment for arthroplasty procedures is to be derived by combining loss of ROM, if any, with arthroplasty impairment under Table 27.
The appeals panel wrote that The language contained on page 3/58 was ambiguous, whereas the language on page 3/62 provided more clear instruction regarding the rating of arthroplasty procedures. Therefore, the panel held that impairment for a distal clavicle resection arthroplasty that was received as treatment for the compensable injury results in 10% UE impairment under Table 27, which is then combined with ROM impairment, if any, as provided by the AMA Guides. The appeals panel cautioned, however, that the manner of assessing loss of ROM, including but not limited to whether or not loss of ROM should be invalidated or the comparison of ROM of a contralateral joint, remains within the discretion of the certifying doctor.
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