How to Determine the Level of Disability for a Back Injury in Workers’ Compensation Cases

BY DANIEL ALVAREZ

When dealing with workers’ compensation cases, determining the level of disability for a back injury is crucial. It involves understanding the medical condition, its impact on daily activities, and applying standardized guidelines. Here’s a simplified approach to help lawyers and claims adjusters navigate this process effectively, drawing on the principles outlined in Chapter 15 of the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition.

Understanding Back Injuries

Back injuries can range from mild strains to severe spinal damage. The spine is divided into four regions: cervical (neck), thoracic (mid-back), lumbar (lower back), and sacral (pelvic area). The most common workplace back injuries occur in the lumbar region. Key factors to consider include:

• Nature of Injury: What type of injury has occurred? This could be a muscle strain, disc herniation, spinal stenosis, or vertebral fracture.
• Symptoms: These include pain, numbness, weakness, and reduced mobility. It’s important to document how these symptoms affect the person’s ability to perform daily activities.
• Medical Stability: The condition should be stable, meaning it is unlikely to change within the next year regardless of treatment. This is known as reaching Maximum Medical Improvement (MMI).

Steps to Determine Disability Level

1. Medical History and Physical Examination:
   • Comprehensive History: Gather detailed information about the patient’s symptoms, how they affect daily life, and any previous back issues.
   • Physical Exam: Conduct a thorough examination to assess pain levels, muscle strength, range of motion, and neurological function.
2. Diagnostic Tests:
   • Utilize relevant tests such as X-rays, MRI, CT scans, and electromyography (EMG) to identify the nature and extent of the injury.
   • Document any abnormal findings like herniated discs, spinal stenosis, or nerve damage.
3. Assessment Methods:
   • Diagnosis-Related Estimates (DRE) Method: This is the primary method for evaluating back injuries due to trauma. It categorizes impairments based on specific criteria, such as muscle spasm, reflex changes, and radiculopathy (nerve root pain).
   • Range of Motion (ROM) Method: Used when the DRE method is not applicable. It assesses the limitation in the spine’s range of motion, combining it with other clinical findings like nerve deficits.
4. Classifying the Injury:
   • Use the DRE or ROM method to classify the injury into specific categories, which correspond to a percentage of Whole Person Impairment (WPI).
   • Example: A person with a mild lumbar strain might fall into DRE Category I (0% WPI), while someone with a severe disc herniation and nerve root compression could be in DRE Category III (10-13% WPI).
5. Combining Impairments:
   • If the injury involves multiple spinal regions or additional conditions (e.g., neurological deficits), combine the impairments using the Combined Values Chart provided in the Guides.
6. Documenting Findings:
   • Create a detailed report that includes the patient’s history, examination findings, diagnostic test results, and how the impairment rating was calculated. This ensures transparency and aids in the review process by other medical and legal professionals.

Practical Example

Consider a case where a worker falls and sustains a lumbar spine injury resulting in a burst fracture at L2 with nerve damage (cauda equina syndrome). Here’s how you might determine the disability level:

• History and Symptoms: The worker has severe pain, weakness in both legs, and bladder control issues.
• Physical Exam: Shows significant muscle weakness, numbness in the lower extremities, and absent reflexes.
• Diagnostic Tests: X-rays and MRI confirm a burst fracture at L2 with spinal cord compression.

Using the DRE method:

• DRE Category: Based on the severity (burst fracture with nerve damage), this injury might fall into DRE Category V, indicating a significant impairment.
• Impairment Rating: A severe impairment like this could result in a WPI rating of 50-70%.

The final step involves compiling this data into a comprehensive report, ensuring all aspects of the injury and its impact on the worker’s daily life are clearly documented.

Conclusion

Determining the level of disability for a back injury in workers’ compensation cases involves a systematic approach. By gathering detailed medical history, conducting thorough physical examinations, using appropriate diagnostic tests, and applying standardized assessment methods, you can accurately determine the impairment level. This process ensures fair and consistent evaluations, aiding in the appropriate compensation for injured workers.