APD Affirms that 10% UE Impairment for Distal Clavicle Excision is Not “Automatic”

We find that some ALJs continue to believe, erroneously, that if a Claimant undergoes distal clavicle excision as part of a shoulder surgery, 10% for upper extremity impairment is automatically added.

In APD 221683, decided December 19, 2022, the AP again affirmed that this is not necessarily the case.

The issues were MMI and IR.  The parties stipulated that the claimant sustained a compensable injury in the form of a right shoulder contusion and Grade 1 sprain/strain, cervical sprain, crushed right wrist, right wrist partial thickness tear of the extensor carpi ulnaris, and tear of the triangular fibrocartilage of the right wrist.

For the right shoulder, the designated doctor assigned a 7% UE impairment based on ROM deficits.  He then stated that the claimant has had a distal clavicular excision which yields an additional 10% UE impairment.  Combining the 10% UE impairment with the 7% UE impairment resulted in a 16% UE impairment for the right shoulder.

The ALJ adopted the DD’s ultimate whole body IR.  The AP reversed that decision.

The operative report indicated the claimant underwent arthroscopy of the right shoulder with repair of the posterior and posterior superior labrum, excision of the distal clavicle, and biceps tendon tenodesis.  The preoperative and postoperative diagnoses listed in the report were right shoulder with posterior superior and posterior labral tear, biceps tendinitis of the right shoulder, severe impingement of the right shoulder, and right acromioclavicular arthritis.  As discussed above, the compensable right shoulder conditions in this case were a right shoulder contusion and a right shoulder Grade 1 sprain/strain.  The distal clavicle resection the claimant received was therefore NOT done as treatment of the compensable injury.  Therefore, the AP held that the DD improperly included the 10% UE impairment from Table 27 in his assigned IR.

The AP noted their prior decision in APD 151158-s, decided August 4, 2015, in which they 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 on page 3/61 of the AMA Guides.