Dr. Larry Van Such, DC, BE, EE
2240 Morse Road
Columbus, Ohio 43229
April 26, 2012
The Law Offices
Re: Joe Jones
Dear Mr. Jones:
The following is in regards to your client, Joe Jones, who presented to our office on April 26, 2012, for examination in regards to the above-mentioned work injury in reference to percentage of Whole Person Permanent Partial Impairment, utilizing AMA Guides, 5th Edition.
HISTORY AND MECHANISM:
Joe Jones presented with ongoing complaints of lower back pain and right leg 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: “I was carrying a box of pipes on my right shoulder, and carrying a ladder in my right hand when I slipped in the mud. I twisted to keep from falling and hurt my back.” The first doctor he saw after the accident was Dr. James, who examined the patient and took x-rays. He then saw Dr. Evans, who performed an MRI and eventually performed surgery. Mr. Jones is currently seeing Dr. Evans for this injury.
PAST MEDICAL HISTORY:
Joe Jones denies having had any other accidents involving the allowances in this claim either before or after the date of this injury.
CURRENT COMPLAINTS AND STATUS:
Joe Jones explained that he still works for the above-mentioned employer. The patient states that he missed six months of work. Joe Jones states that the pain comes and goes. He rates his pain as a 4-6/10 on the VAS. He describes the pain as a tingling, numb, aching, and cramping sensation. The patient states that he has limited mobility of his lower back and right leg. 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, cutting lawn, shoveling snow, raking leaves, driving a car, sitting too long, standing, walking, lying down, running, jogging, fishing, hiking, shopping, grocery shopping, and bathing. Joe Jones explained that as the weather changes, his pain worsens. He is taking Tizanidine and Oxycodone for this injury.
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. Mr. Jones is given 1% 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 +1 and symmetrical of patella and Achilles.
Muscle guarding was palpated over the lumbar erector spinae muscles and quadratus lumborum bilaterally.
Straight leg raise test is positive at 35 degrees on the right and 45 degrees on the left.
Milgrams, Kemps and Bechterews tests were positive.
Calf circumference: Right = 32.5 cm. Left = 32.5 cm.
Braces and supports: as needed.
No discoloration or bruising was noted.
Surgery: yes. 7 cm scar over the midline lower lumbar region of the spine.
Heel to toe walk was weak and unsteady.
Gait: right foot turns out while walking.
Coughing and sneezing aggravate the lower back.
Lumbar Range of Motion
The range of motion method is used due to multilevel involvement and/or alteration of motion segment integrity occurrence in the same spinal region. Reference Section 15.8, page 398.
A) Flexion = 5% impairment.
B) Extension = 3% impairment.
C) Left Lateral Flexion = 3% impairment.
D) Right Lateral Flexion = 3% impairment.
Total whole person impairment = 14% WPI, based on AMA Guides, 5th Edition, Chapter 15, Table 15-8, page 407 and Table 15-9, page 409.
Criteria for Rating Whole Person Impairment Percent Due to Specific
Spine Disorders to Be Used as Part of the ROM Method.
Table 15-7, Page 404
Section II. Intervertebral disc or other soft tissue lesion; Herniated nucleus pulposus L5-S1.
Item e: Surgically treated disk lesion with residual, medically documented pain and rigidity equates to a 10% WPI.
Radiculopathy involving the sciatic nerve and its branches into
the right lower extremity and foot. SCIATICA
Impairments Due to Nerve Deficits (Sciatic):
Maximum Sensory (7% WPI) and Motor (30% WPI) Nerve Combined Value = 35% WPI
Table 17-37, Page 552
Sensory: the patient had diminished sensory perception during pinwheel testing and hot and cold testing over the L5 and S1 dermatomes of the right lower extremity.
Table 16-10, page 482.
Grade 3/5 Sensory deficit; 26-60%.
50% times 7% WPI (Sensory nerve maximum) = 3.5% rounded down = 3% WPI.
Motor: muscle strength deficits were noted during right ankle plantarflexion involving the gastrocnemius and soleus muscles; extensor hallicus longus muscle; and flexor digitorum longus and brevis.
Table 16-11, page 484
Grade 4/5 Motor deficit; 1-25%.
25% times 30% WPI (Motor nerve maximum) = 7.5% rounded up to offset sensory calculation = 8% WPI.
8% WPI combined with 3% WPI = 11% WPI Radiculopathy.
Total WPI Calculation
Using Combined Values Chart Page 604
14% WPI (ROM) combined with11% WPI (Radiculopathy) = 24% WPI
24% WPI combined with 10% WPI (Disc Surgery) = 32% WPI
32% WPI + 1% WPI (Pain/ADL’s) = 33% WPI
DISCUSSION AND OPINION:
The following impairment rating has been given to Joe Jones after a thorough history, orthopedics, neurological, muscle testing, and range of motion examinations were performed on April 26, 2012; it is my professional opinion that Joe Jones has sustained a 33% WPI.
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.