Background:
Sprague suffered a 1999 low back injury and underwent surgical procedures in 1999 and 2003. Lucas sought to establish permanent impairment below the 11.8% threshold applicable to Sprague’s date of injury. The Act requires that permanent impairment be determined according to the 4th Edition of the AMA Guides to the Evaluation of Permanent Impairment (“the Guides”). Chapter 3 of the Guides applies to spine injuries and provides that the evaluator should use the “Injury” or “DRE” model if the patient’s condition fits within one of eight listed categories. It goes on to provide that if the condition does not fit into one of the eight categories, the physician should use the range of motion model as a differentiator to decide placement within one of the DRE categories.
In this case, Sprague’s own physician used the DRE model and assigned 10% permanent impairment. A 312 exam was conducted and the examiner used the range of motion model, reasoning that because Sprague had multiple surgeries he did not fit neatly within any of the DRE categories. Using the range of motion model, he assigned 12% permanent impairment.
The Hearing Officer adopted the 312 examiner’s opinion. Lucas appealed, contending that the 312 examiner should have used the range of motion model merely to place the employee in the proper DRE category, not as an assessment tool in and of itself.
Court ruling:
The Court found no error in the 312 examiner’s use of the range of motion model in assessing permanent impairment. The Court found enough support in the language of the Guides to use the range of motion model in and of itself to assess permanent impairment in some circumstances, and not just as a tool to differentiate between categories in the DRE model. In this case, the independent medical examiner concluded that Sprague’s condition did not fit neatly within any of the DRE categories so that the range of motion model provided the best estimate of his permanent impairment. This gives the examiner a good deal of flexibility in rating permanent impairment, providing the examiner can support that the condition doesn’t fit squarely within one of the DRE categories. That appears to be a fairly low threshold and could result in a wide range of ratings regarding the same condition.
View complete text of David J. Sprague v. Lucas Tree Experts, et al.