Dr. Larry Van Such, DC, BE, EE
2240 Morse Road
Columbus, Ohio 43229
January 5, 2009
Law Offices of Jones and Jones
Re: John Doe
Claim Number: 05-555555
Allowances: SPRAIN ANKLE LEFT
ACHILLES TENDONITIS LEFT
Employer: CLASSIC SOLUTIONS
Date of Birth: 01/08/1972
Social Security #: 555-55-5555
Dear Mr. Jones:
The following is in regards to your client, John Doe, who presented to our office on January 5, 2009, for examination in regards to the above-mentioned industrial related incident in reference to percentage of Whole Person Permanent Partial Impairment, utilizing AMA Guides, 5th Edition.
HISTORY AND MECHANISM:
John Doe presented with ongoing complaints of left ankle pain. He states that these complaints have been present since being involved in an industrial related accident that occurred on the above-mentioned date. He described the mechanism of the injury as when he tripped over steel track and twisted his ankle. The first doctor he saw after the accident was Dr. Mason.
CURRENT COMPLAINTS AND STATUS:
John Doe explained that he no longer works for the above-mentioned employer. The patient states that he did not miss any work due to the injury. Mr. Doe states that the pain is constant. He states that his pain is 7/10 on the VAS scale. He describes the pain as a sharp, burning, throbbing, stiffness, and aching sensation. The patient states that he has limited mobility of his left ankle. He states that this injury interferes with his work, sleep, daily routine, and recreation. With limited use of his left ankle, it is difficult or impossible for him to perform the following activities: climbing stairs, standing, walking, playing sports, running, sleeping, standing, and hiking.
All of the above mentioned complications fall under the chronic pain category where up to 3% impairment is given/added to this claim based on the ongoing burden of illness disrupting activities of daily living. John is given 2% WPI today. Reference AMA guides, 5th edition, Chapter 18, Tables 18-1, 18-3, 18-4, 18-5, 18-6 and page 584 item 5b.
Deep tendon reflexes were not performed due to pain. Medial and lateral stress tests produced pain. Heel/toe walk was unstable and weak in the left ankle. No swelling was detected at the time of the examination. Tenderness was elicited in the gastrocnemius muscle in the left due to Achilles tendonitis. Talofibular ligament was painful upon palpation indicative of ligament sprain. Tibial-calcaneal ligament was painful upon palpation of indicative of ligament sprain.
Left ankle range of motion
LEFT ANKLE IMPRESSION:
A.) Dorsiflexion = 7% impairment.
AMA Guides, Chapter 17, page 537, table 17-11 and 17-12, reveals an 18% LEI of the left ankle.
Sensory Testing: Patient was unable to discern between two sharp point of contact at a distance of 50 mm (<5mm is normal) across the L5 and S1 dermatomes of the left ankle. Reference AMA Guides, Chapter 15, page 424, Table 15-18, this equates to a 5% LEI.
Total LEI Calculation
Using combined values chart page 604
18% combined with 5% = 22%LEI
Total WPI Calculation
A 22% LEI = 9% WPI. Reference Table 17-3, page 527.
DISCUSSION AND OPINION:
The following impairment rating has been given to John Doe after a thorough history, orthopedics, neurological, and range of motion examinations were performed on January 5th, 2009. It is my professional opinion that Mr. Doe has sustained a 11% Whole Person Impairment.
This impairment rating falls into the Range of Motion category, November 2000, 5th Edition AMA Guides to the Evaluation of Permanent Impairment.
Dr. Larry Van Such, D.C., B.E.
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