When assigning permanent impairment for a spinal injury under the AMA Guides, 5th Edition, two primary pathways emerge: the Diagnosis-Related Estimates (DRE) method and the Range of Motion (ROM) method. The stakes are high for claims adjusters, as choosing the proper approach—and scrutinizing the results—can drastically impact claim reserves and settlement strategies. Below is a deeper look at how each method works, how to analyze the final numbers, and ways to challenge an improperly applied ROM method.
Understanding the DRE Method
- Diagnosis-Centric Approach
The DRE method hinges on objective clinical diagnoses—such as verified disc herniations, fractures, or radiculopathy—rather than purely on measurements of movement. Each spinal region (cervical, thoracic, and lumbar) has DRE categories (I through V) outlining the typical anatomic or neurologic findings that correspond to various impairment ranges. - Objective Testing Matters
Reliable imaging and diagnostic studies (MRI, EMG/NCS, etc.) help place the injured worker in the correct DRE category. For instance, a single-level disc herniation with confirmed nerve root compression might point to a distinct DRE category, while stable degenerative disc disease might fall into another. - Straightforward Framework
Since each DRE category aligns with specific medical findings, disputes often revolve around whether those findings exist, rather than questions about patient effort or measuring techniques. This can make DRE less prone to subjective variation—though accurate diagnosis is still critical.
Understanding the ROM Method
- Measurement-Based System
The ROM method calculates impairment using flexion, extension, and lateral bending measurements, in conjunction with certain diagnostic components. An examiner will measure the range of motion in each plane multiple times to ensure consistency and then apply the AMA Guides’ formulas to arrive at an impairment percentage. - More Variables = More Vulnerabilities
While the ROM method can capture the total functional loss for more complex or multi-level conditions, it introduces many variables—examiner technique, patient compliance, and environmental factors (like warm-up exercises, pain medications, or bracing). Even small measurement discrepancies can yield significantly different impairment ratings. - When to Use ROM
The AMA Guides, 5th Edition generally recommend DRE for most spinal injuries. However, if a claimant has had multiple surgeries, multiple-level problems, or complex clinical features not neatly covered by a single DRE category, the ROM method might be appropriate.
Analytical Framework for Spinal Impairment Cases
- Identify the Proper Method
- Is there a valid reason to use ROM? Check for multi-level or post-surgical situations that might merit the ROM approach. If the medical report uses ROM without justification, this could be a red flag.
- Does the clinical evidence support a specific DRE category? If the diagnosis aligns cleanly with one of the categories, the DRE method is typically more straightforward and is the default choice in most scenarios.
- Scrutinize the Documentation
- DRE Reports: Ensure objective diagnostic findings (imaging, EMG, neurological deficits) support the chosen category.
- ROM Reports: Confirm that the report details measuring techniques, repeats measurements as required and accurately applies the AMA Guides’ formulas.
- Check for Internal Consistency
- Compare the final impairment rating with the described clinical picture. If the impairment rating seems too high or too low relative to the objective findings, dig deeper.
- Look for conflicting information, such as a single-level injury that is suddenly categorized under ROM or measurements that vary wildly between visits.
Challenging an Improperly Applied ROM Method
- Ask for Repeated Measurements
The AMA Guides specify that range-of-motion measurements should be repeated multiple times to establish reliability. If the physician only did one set of measurements or they failed to document the repetition, question the consistency. - Verify Patient Effort
Did the claimant fully cooperate? Is there documentation about suboptimal effort, secondary gain issues, or pain-limited testing? These factors can inflate impairment ratings. - Confirm Equipment & Protocol
Assess whether the tools (e.g., goniometers) and methods align with the Guides’ standards. Even small deviations can undermine the validity of the measurements. - Look for Overlapping Diagnoses
Ensure that the final rating does not double-count the same condition. Overlaps between multiple diagnoses can lead to erroneous additive impairment if not carefully accounted for.
Sometimes, assigning the correct impairment rating—and defending it—requires more nuanced legal insight. With offices spanning Fresno, Bakersfield, Salinas, Sacramento, Pasadena, and San Diego, our team at Yrulegui & Roberts works closely with claims adjusters, employers, and carriers to navigate these complexities. We combine a deep understanding of the AMA Guides with practical strategies to ensure each case is handled efficiently and fairly.
Legal Disclaimer
This information is provided for general educational purposes and is not intended as legal advice. No attorney-client relationship is created by reading or using this material. For advice regarding your particular situation, please consult qualified legal counsel.
