Northtowne Chiropractic
Dr. Larry Van Such, DC, BE
Dr. Rick Horsfield, DC
Jamie Ike, LMT

2240 Morse Road
Columbus, Ohio 43229

Office Hours
Mon & Wed   9am - 12pm
  3pm - 5pm
Tue & Thur   12pm - 5pm
Fri   9am - 3pm
Sat   By Appt Only

(614) 428-9310

Welcome!  You have reached my examination report page. These are actual medical reports submitted to the Ohio BWC on behalf of my patients.  The lumbar sprain report is shown below these images and links. 

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Spinal Decompression

Back Pain

Neck Pain


Chiropractic Adjustment

Sciatica Leg Pain

Car Accident

Herniated Discs

Dr. Larry Van Such, DC, BE, EE
2240 Morse Road
Columbus, Ohio 43229
(614) 428-9310

October 30th, 2008

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

Re:  Jane Doe
Claim Number:    97-555555
D.O.I.:    01/10/1997
Allowances:  722.10- LUMBAR DISC DISPLACEMENT L4-L5
Employer:              H.F.I.
Date of Birth:       06/09/1955
Social Security #: 123-45-6789


Dear Mr. Jones:

The following is in regards to your client, Jane Doe, who presented to our office on October 30th, 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, 5th Edition.


Jane Doe presented with ongoing complaints of low back pain and pelvic pain.  She states that these complaints have been present since being involved in an industrial related accident that occurred on the above-mentioned date.  She described the mechanism of the injury as when she was lifting a wooden skid when she started to bend over to lay it down she felt a sharp pain in her low back.  The first doctor she saw after the accident was Dr. Scott Hirth who referred her to Dr. Crowell.  Mrs. Doel went to Dr. Crowell who performed back surgery on her.  Mrs. Doel then went to Dr. Charles May who is still her treating physician. 


She denies any previous accidents or injuries to her low back prior to or after the above-mentioned date. 


Jane Doe explained that she no longer works for the above-mentioned employer since she is now retired. The patient states that she missed about six weeks of work.  Jane states that the pain is constant.  She describes that pain as a sharp, cramping, stiffness, aching, and shooting sensation.  The patient has tried to alleviate the pain/symptoms by wearing a back brace, taking medication, using a cane, and limiting her activities.  The patient states that she has limited mobility of her low back.  She states that this injury interferes with her sleep and daily routine.  With limited use of low back, it is difficult or impossible for her to perform the following activities:  climbing stairs, running sweeper, cutting lawn, shoveling snow, raking leaves, gardening, sitting too long, playing with grandkids, exercising, sleeping, standing, and using her hands.  Mrs. Doe explains that as the weather gets colder her pain increases. 

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.   Jane is given 3% 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.

Musculoskeletal Examination

Deep tendon reflexes were +2 and symmetrical of patella and Achilles.  Muscle guarding was palpated over the erector spinae muscles bilaterally from L1-L5 and quadratus lumborum bilaterally.  Postural analysis revealed an elevated ilium on the left side indicative of asymmetrical muscle tone in the gluteus medius and psoas muscles.  Motion palpation of the lumbar spine revealed restrictions at L4 and L5 during extension; L3, L4, and L5 during right and left lateral bending.  Straight leg raise test is positive at 10 degrees bilaterally; Nachlasís test is positive for lumbar involvement.

Range of Motion

 16 degrees
60 degrees
 7 degrees
25 degrees
Left Lateral Flexion
 8 degrees
25 degrees
Right Lateral Flexion
 7 degrees
25 degrees

A.)  Flexion = 7% impairment.

B.)  Extension = 5% impairment.

C.)  Left Lateral Flexion = 3% impairment.

D.)  Right Lateral Flexion = 3% impairment.

Total whole person impairment = 18% WPI, based on  AMA Guides, 5th Edition, Chapter 15, Table 15-8, page 407 and Table 15-9, page 409.

Reference AMA Guide, 5th Edition, Chapter 15, page 404, Table 15-7, Criteria for rating whole person impairment due to specific spine disorders.  Section II.  Intervertebral disc or other soft tissue lesion; Lumbar disc displacement at L4/L5 with mild to moderate canal stenosis. Item c:  Unoperated on stable, with medically documented injury, pain and rigidity associated with moderate to severe degenerative changes on structural tests, includes a herniated nucleus pulposus with or without radiculopathy is equal to a 7% WPI.  Add 1% per additional level, Item F: L5/S1 disc protrusion equates to an 8% WPI.

Total Whole Person Impairment Calculation
using combined values chart on page 604:

18% combined with 8% = 25%

25% + 3% (Pain/ADL's) = 28% WPI


The following impairment rating has been given to Jane Doe after a thorough history, orthopedics, neurological, muscle testing, and range of motion examinations were performed on October 30th, 2008.  It is my professional opinion that Jane Doe has sustained a 28% 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.

Respectfully Submitted,
Dr. Larry Van Such, D.C., B.E.
CC:  File

Low Back Pain   Causes, treatments, and relief through chiropractic care