Impairment Rating - Medical Proof of Injury

Using the American Medical Association's Guide to the Evaluation of Permanent Impairment

There is a difference between an impairment and a disability. An impairment is the inability of a certain part of the body to function properly. A disability occurs when the impaired bodily function inhibits personal, social, or occupational demands.

For example, according to the AMA guidelines, the loss of five fingers on one hand would be an impairment of 90% of that extremity. Additionally, this would represent a 54% whole-person impairment. If the injury occurred to a professional baseball pitcher, it is obvious that the injury would represent a 100% disability to that person. On the other hand, a soccer player may still be perfectly able to run and play soccer. The soccer player's disability would be significantly less.

On a more technical level there are impairments that may not be as visible as the loss of an extremity. For example, a person's neck should have a certain range of motion as he moves his head forward and backward. That range of motion should be somewhat evenly distributed across each vertebrae in the cervical spine. If a patient has insufficient total range of motion over the cervical spine then a possible problem exists. Additionally, if the patient has sufficient range of cervical motion, but the motion is concentrated in one or two vertebral segments, then the patient may look and feel fine, but the overworked vertebrae and disc will eventually deteriorate with time. Clearly, if this condition exists an injured patient may be compensated for their permanent injury. Unless the patient or their attorney can prove that the injury exists, then compensation for that injury may not be obtained. Complications will result after the insurance company is relieved of all liability.

There is a way to measure, document and prove impairments to the cervical and lumbar spines through the analysis of x-ray films. When cervical lateral flexion and extension films are viewed and compared, the motion of each vertebrae becomes visible. What is measured is the relative position of any vertebrae compared to the one above it or below it. This data is collected from both flexion and extension views to determine if any one vertebrae rotates too much (Loss of Motion Segment Integrity - Angular Motion) or if any one vertebrae slides back and forth too much (Loss of Motion Segment Integrity - Translation). If any cervical vertebrae rotates more than 11 degrees more than the vertebrae above it or below it then an automatic 25% whole person impairment exists. Additionally, if any vertebrae slides (translates) back and forth more than 3.5 millimeters relative to an adjacent vertebrae then an automatic 25% whole person impairment also exists. In the lumbar spine 5 millimeters of translation is required for an impairment to exist.

Progressive Diagnostic Imaging has ability to allow for the necessary image management and measurement extraction and has computerized the application of this test. The reports make excellent use of the procedures outlined by the American Medical Association in the Guide to the Evaluation of Permanent Impairment.

Unfortunately, the manual application of the guide is cumbersome and not well fitted to simple reproducible documentation. Progressive Diagnostic Imaging has removed this barrier by providing printed photographic-quality documentation and an objective third-party analysis of findings.

Any patient who has been injured is a candidate for the analysis. When it comes to proving the existence of a permanent whole-person impairment due to an injury, this could be the most objective proof, when appropriately correlated with clinical findings.