Texas Appeals Panel Decision Nos. 100234 and 100264 – AMA Guides

Texas Appeals Panel Decision Nos. 100234 and 100264 – AMA Guides

   By Stuart D. Colburn, Shareholder, Downs Stanford

Appeals Panel Decision No. 100234 – AMA Guides

The Claimant sustained a compensable low-back injury.  He underwent spinal surgery, suffered an infection, and underwent numerous surgeries in an attempt to remove the infection.  He ended up developing L3-4 discitis and osteomyelitis.  The Designated Doctor certified a 28% impairment rating: 10% for lumbar radiculopathy and 20% for gait derangement pursuant to Table 36, page 3/76 of the AMA Guides.

The Appeals Panel reversed the Hearing Officer’s decision, holding the Claimant did not sustain an injury to his legs.  The Appeals Panel cited page 3/75 holding that gait derangement impairment is not appropriate for low-back injuries.  The proper impairment rating was to be calculated for his low back injury.  The Appeals Panel found the Claimant’s impairment rating as 10%.

Appeals Panel Decision No. 100264AMA Guides

This case resolved a conflict between Figure 29 on page 3/38 and the directions found on page 3/37 of the AMA Guides (Fourth Edition).  According to page 3/37, the measurements should be rounded to the nearest 10 degrees.  Figure 29 rounds measurement to the nearest five degrees.  The AMA Guides page 2/9 states that an impairment value may be adjusted unless the book gives other directions.  The Appeals Panel felt that the directions given on page 3/37 trump Figure 29 found on page 3/38.  Therefore, upper extremity impairment should be calculated by rounding first to the nearest 10 degrees.  The Appeals Panel reversed the Hearing Officer’s adoption of the Designated Doctor’s impairment rating and remanded for follow-up with the Designated Doctor.