Law Offices of Jones and Jones, LLC
Law Office-Attorney at Law
1234 High Street
Columbus, Ohio  43201
Telephone:  (614) 555-5555
Facsimile:   (614) 555-5556     

The following is in regards to your client, John Doe, who presented to our office on November 26^th, 2008, for examination in regards to the above-mentioned industrial related incident in reference to percentage of Whole Person Permanent Partial Impairment, utilizing AMA Guides, 5^th Edition.

John Doei presented with ongoing complaints of lower back pain, hip pain and pelvic 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 was lifting an almost 100lb. rug by himself when he felt pain in his lower back. 

CURRENT COMPLAINTS AND STATUS:

John Doe explained that he no longer works for the above-mentioned employer. The patient states that he missed work due to the injury.  Mr. Doe states that the pain comes and goes, worse in the morning and the evening.  He describes the pain as a cramps, numbness, stiffness, and aching sensation.  The patient has tried to alleviate the pain/symptoms by taking medication and applying ice/heat packs, and doing back exercises.  The patient states that he has limited mobility of his lower back.  He states that this injury interferes with his work, sleep, daily routine, and recreation.  With limited use of his lower back, it is difficult or impossible for him to perform the following activities:  climbing stairs, doing laundry, doing dishes, running sweeper, shoveling snow, driving a car, sitting too long, playing sports, playing with kids, lifting weights, exercising, running, jogging, sleeping, standing, and grocery shopping.  Mr. Doe explains that as the weather gets colder it makes it difficult for him to sleep and to walk in the morning. 

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 1% WPI today.  Reference AMA guides, 5^th edition, Chapter 18, Tables 18-1, 18-3, 18-4, 18-5, 18-6 and page 584 item 5b.

Deep tendon reflexes were +2 and symmetrical of patella and Achilles.  Muscle guarding was palpated over the erector spinae muscles bilaterally from L5-S1 and quadratus lumborum bilaterally.  Postural analysis revealed an elevated ilium on the right side indicative of asymmetrical muscle tone in the gluteus medius and psoas muscles.  Motion palpation of the sacroiliac joints revealed restrictions during flexion. Nachlas’s test is positive bilaterally. Ely’s test is positive bilaterally.  Hibb test is positive bilaterally.

Dorsolumbar ranges of motion (digital inclinometer):

A.)  Flexion = 5% impairment.
B.)  Extension = 3% impairment.
C.)  Left Lateral Flexion = 1% impairment.
D.)  Right Lateral Flexion = 2% impairment.

Total whole person impairment = 11%WPI, based on  AMA Guides, 5^th Edition, Chapter 15, Table 15-8, page 407 and Table 15-9, page 409.

DISCUSSION AND OPINION: 

The following impairment rating has been given to John Doe after a thorough history, orthopedics, neurological, muscle testing, and range of motion examinations were performed on November 26^th, 2008.  It is my professional opinion that Mr. Doe has sustained a  12% Whole Person Impairment.

This impairment rating falls into the Range of Motion category, November 2000, 5^th Edition AMA Guides to the Evaluation of Permanent Impairment.