Appeals Panel Describes Proper Method to Calculate Brachial Plexus Injuries

The Appeals Panel has reversed the decision of a Hearing Officer who concluded that that a claimant reached MMI with a 13 percent whole body impairment rating calculated, in part, by including a brachial plexus (right shoulder) injury. The Hearing Officer determined that the compensable injury extended to and included the brachial plexus, a collection of nerves that control the muscles in the shoulder and provide feeling in the arm. In Appeals Panel Decision Number 160229, decided April 11, 2016, the Appeals Panel reversed the Hearing Officer’s determination and remanded the case with instructions.

A division-appointed designated doctor evaluated the claimant and provided a series of whole body impairment ratings. Rating number one assigned an IR of 5 percent for the claimant’s cervical strain pursuant to DRE Cervicothoracic Category II together with a 9 percent IR for range of motion loss of the right upper extremity, which combined for a total whole person IR of 14 percent.

Rating number two, which was assigned after the issuance of an LOC, found a 23 percent IR, which was calculated using 5 percent IR under DRE Category II for the cervical strain together with 19 percent whole person impairment calculated using Table 15 on page 3/54 of the Guides, Table 11a on page 3/48 of the Guides and Table 12b on page 3/49 of the Guides for peripheral nerve impairment combined with abnormal motion impairment of the right upper extremity. The Division issued a second LOC, following which the designated doctor acknowledged that he had erred in combining a peripheral nerve system impairment with an abnormal motion impairment of the right upper extremity.

Thereafter, the designated doctor issued rating number three, which provided a 13 percent certification. This certification was derived from a 5 percent peripheral nerve system impairment of the suprascapular nerve using Tables 15 and 12b of the AMA Guides together with a 9 percent regional impairment of the right upper extremity from abnormal motion yielding a whole body impairment of 8 percent for the right upper extremity which was combined with a 5 percent impairment under DRE Category II for the cervical strain.

The Hearing Officer adopted the 13 percent rating. The Appeals Panel held that the 13 percent impairment rating was incorrectly calculated.

We note further that the AMA Guides provide specific instructions on pages 3/52 and 3/53 and under Table 14, page 3/52 for rating brachial plexus-related impairments; however, Dr. J chose instead to provide a rating under Table 15, page 3/54 of the Guides for peripheral nerve impairment, a condition not determined to be part of the compensable injury. Because Dr. J failed to rate the compensable brachial plexus to the right shoulder, right arm, right wrist, and right hand as instructed by the AMA Guides or to provide an explanation for his decision to instead provide an IR for peripheral nerve deficit, we reverse the Hearing Officer’s determination that the claimant reached MMI on May 7, 2013, with a 13% IR.

The decision provides three helpful lessons. First, an impairment rating for peripheral nerve injuries cannot combine impairment for the nerve impairment with impairment for lost range of motion. This results in a duplication of impairment. Second, a brachial plexus injury cannot be rated using the table designed to rate peripheral nerve injuries. Third, brachial plexus injuries should be rated using the specific instructions found on pages 3/52 and 3/53 and under Table 14, page 3/52 of the Guides.