Luis Pérez-Cordero Permanent Disability Rating Specialist pdrating@pacbell.net	California Permanent Disability Ratings WWW.PDRATINGS.COM Voice: (415)-861-4040	Craig A. Lange Administrator/Medical Report Tech craiglange@pacbell.net
Southern California Fax #: (619) 374-7334 Central Valley Fax #: (916) 848-3582 / Bay Area Fax #: (415) 276-3741
The Nuts And Bolts Of The Einstein-Horner Calculation What To Do When Rating Overlapping Subjective Factors Of Disability
I. The Terminology of Subjective Disability: DWC-California Rating Schedule - Pages 1-3, 1-7 & 1-8 Pain is not always disabling. It becomes disabling when its degree affects function. Regulations define four degrees of subjective pain - minimal, slight, moderate and severe. By definition minimal (mild) pain is not disabling because it causes no handicap in the activity precipitating the pain. However, slight, moderate and severe pain reflects increasingly greater degrees of handicap on work activity, and is ratable factors of disability. Pain (Subjective Disability) is characterized in terms of body part affected, intensity, frequency, and activity giving rise to the pain. Subjective Disability must always be described by the frequency, severity and activities that produce the pain. A Severity Levels & Scheduled Values: Spine & Torso Guidelines - Schedule, pgs. 2-14 & 2-15. Turn to “Subjective Factors As Index of Disability “ Under this column the terms listed are defined as having the following values: 1. Constant Slight: (10% Rating Standard of Permanent Disability) 2. Constant Slight To Moderate: (30% Rating Standard of Permanent Disability) 3. Constant Moderate: (50% Rating Standard of Permanent Disability) 4. Constant Severe: (100% Rating Standard of Permanent Disability) Û ÛDisabilities 12.16, 12.32,14.113,14.133.14.871 and 7.143 (Loss of Both hands at Wrist Joints.) B Severity Level Pain Scale: The above definitions establish the groundwork for the following values: 1. SEVERE: Pain that Precludes Activity causing the pain. (Loss of Work Capacity» Analogous to the rating standards of immobility or the Work Restrictions. » 100% functional loss. 2. MODERATE-TO-SEVERE: Pain that causes substantial handicap but allows occasional performance of the activities precipitating the pain. » 75% functional loss. 3. MODERATE: Pain that can be tolerated and causes would cause a marked handicap in the performance of the activity precipitating the pain. » 50% functional loss. 4. SLIGHT-TO-MODERATE: Pain initiating at a level of hardly any handicap exacerbated to cause an increased level of handicap in the performance of the activity precipitating the pain. » 30% functional loss. 5. SLIGHT: Pain that could be tolerated but would cause some handicap in the performance of the activity precipitating the pain. » 10% functional loss. 6. MINIMAL-TO SLIGHT: Annoying pain that exacerbates to cause some handicap in the performance of the activity precipitating the pain. » 05% functional loss. 7. MINIMAL/MILD: Pain that constitutes an annoyance but causes no handicap in the performance of the particular activity precipitating the pain. » 00% functional loss. Page 1 of 5

Luis Pérez-Cordero

Permanent Disability Rating Specialist

pdrating@pacbell.net

California Permanent Disability Ratings

WWW.PDRATINGS.COM

Voice: (415)-861-4040

Craig A. Lange

Administrator/Medical Report Tech

craiglange@pacbell.net

Southern California Fax #: (619) 374-7334 Central Valley Fax #: (916) 848-3582 / Bay Area Fax #: (415) 276-3741

The Nuts And Bolts Of The Einstein-Horner Calculation

What To Do When Rating Overlapping Subjective Factors Of Disability

C Frequency Levels:

When the frequency of pain is less than constant, the assigned value decreases proportionately. Rating Schedule – Page 1-7

To describe the frequency with which symptoms occur; the following words are defined as having specific meanings and can be combined to describe an employee's level of subjective factors:

· Rare/Infrequent: Anything Less Than Occasional 1/5 of the time or less.

· Occasional: Approximately 25% or 1/4 of the time.

· Intermittent: Approximately 50% or 1/2 of the time.

· Frequent: Approximately 75% or 3/4 of the time.

· Constant: Approximately 90% to 100% of the time.

1. For Example: When the frequency of pain is less than constant, the assigned value decreases proportionately. Thus, an intermittent slight pain of the minor wrist would be 50% of the value of slight pain in the wrist, or one-half of 05%. Since all ratings are rounded to the nearest whole number the final value would be 03%.” Û

Û When mathematically calculating a rating standard, it should be expressed as one of the following values: 1,2,3,5,8,10,13,15 & multiples of 5% thereafter, before modification for age and occupation. [See Page 1-13 of The Schedule.]

D Basic Level Of Pain: Frequency & Severity Level Chart

To facilitate the values’ calculation for the basic level of pain in the Einstein-Horner Formula, the following chart combines the first two components of Subjective Disability, the frequency and severity levels, before modification for the activities precipitating the pain.

Basic Level Of Pain: Frequency & Severity Level Chart This chart can be used to determine rating standards for subjective factors for: (1) The Spine / (2) The Bilateral Upper Extremities / (3) The Bilateral Lower Extremities B When Addressing Disability To An Entire Upper Or Lower Extremity, Divide All Values by 50% (1/2). When addressing functional loss for one or more joints of an injured extremity, we must not forget how the loss affects specific abilities or overall function. Rating Schedule -Pages 1-8 to 1-13
¯ Severity Key ¯	¯ Frequency Key ¯
	Rare/Infrequent 1/5 – 20%	Occasional ¼ - 25%	Intermittent ½ - 50%	Frequent ¾ - 75%	Constant 90-100%
Minimal To Slight	01%	02%	03%	05%	05%
Slight	02%	03%	05%	08%	10%
Slight To Moderate	05%	08%	15%	20%	30%
Moderate	10%	13%	25%	40%	50%
Moderate To Severe	15%	20%	40%	55%	75%
Severe	20%	25%	50%	75%	100%
The Rating Standard calculations in this table mathematically abide to the rating principles of The Schedule. Standards should be expressed as one of the following values: 1,2,3,5,8,10,13,15 & multiples of 5% thereafter, before modification for age and occupation. Rating Schedule-Page 1-13
LPC (06-05-1998)Ó Copyrighted Material No Part Of This Table May Be Reproduced, Reused, Republished Or Transmitted In Any Form, Or Stored In A Data Base Or Retrieval System, Without Written Permission.

Page 2 of 5

Luis Pérez-Cordero

Permanent Disability Rating Specialist

pdrating@pacbell.net

California Permanent Disability Ratings

WWW.PDRATINGS.COM

Voice: (415)-861-4040

Craig A. Lange

Administrator/Medical Report Tech

craiglange@pacbell.net

Southern California Fax #: (619) 374-7334 Central Valley Fax #: (916) 848-3582 / Bay Area Fax #: (415) 276-3741

The Nuts And Bolts Of The Einstein-Horner Calculation

What To Do When Rating Overlapping Subjective Factors Of Disability

E Determining Equivalent Values for Activities: By ‘Analogy’ or Use of Scheduled Guidelines.

Spine & Torso Guidelines - Schedule, pages 2-14 & 2-15 or

Lower Extremity Guidelines - Schedule, page 2-19 or Lower Extremity Chart on This Web Site

Since work restrictions establish limits of specific activities or tasks due to a disability that impedes an activity, body position & motion the rating standards assigned to the Scheduled Spine & Torso Guidelines or the Lower Extremity Guidelines, when used to describe subjective factors of disability, their scheduled rating standards of permanent disability are equivalent to the severe level of pain.

1. For Example: Einstein-Horner Calculation for Basic Pain (Spine)

a. Constant slight-to-moderate pain with Heavy Lifting:

E.H. Calculation: Basic Pain: 30%(constant slight-to-moderate) x 20 = 06 » 05 Û

b. Occasional slight pain with activities requiring minimal effort (Limitation to Light Work).

E.H. Calculation: Basic Pain: 10% (slight pain) x 50 = 05 x ¼ (occasional) = 1.25 » 01Û

c. Constant moderate pain with Heavy Work (Use the Table!)

E.H. Calculation: Basic Pain: 50% x 30 = 15% Û

d. Frequent moderate Pain With Repetitive Motions of the neck and spine.

E.H. Calculation: Basic Pain: 40% (Use the Table!) x 15% =06 » 05 % Û

Û At the end of the calculation the Rating Standard is expressed as one of the following values: 1,2,3,5,8,10,13,15 & multiples of 5% thereafter, before modification for age and occupation. Rating Schedule-Page 1-13

Work Capacity Functional Loss / Work Capacity Guidelines(Spine) Multiple disability factors will have some redundancy in how they affect specific abilities or overall function, and an unrealistic result will be achieved by simply adding factors together. Multiple factors are compacted (scaled down) to avoid duplication and pyramiding. Rating Schedule-Pages 2-12 to 2-15 Evaluation Guidelines 46, 9725 & 9727.
00	03	05	08	10	13	15	20	25	30	35	40	45	50
Pre-Injury Loss:		10%	15%	20%	25%	30%	40%	50%	55/60	65-70%	75-80%	85-90%	95-100
Spine/Torso Motion:				< 20-25%					50%				80%+
No Fixed Neck/Head =						< No Repetitive Motions of the Neck or Spine
Residual Lifting Capacity for 76-100^lbs^.:				< 51-75			26-50		11-25		0-10 (Minimal Demands for Lifting )
Residual Lifting Capacity for 51-75^lbs^.:				< 26-50		11--25	0-10
				< No Very Heavy Lifting			<No Heavy Lifting
No Very Heavy Work =									< No Heavy Work
No Heavy Lifting Repeated Bending & Stooping =											< No Substantial Work
Limitation to Light Work =
Protracted/Stationary Positioning of the Spine/Extremities: (05%)
Frequency Key: Prolonged (25%) Repetitive (50%) Substantial (75%) Sustain (100%)
LPC (06-05-1998)Ó Copyrighted Material No Part Of This Table May Be Reproduced, Reused, Republished Or Transmitted In Any Form, Or Stored In A Data Base Or Retrieval System, Without Written Permission.

Page 3 of 5

Luis Pérez-Cordero

Permanent Disability Rating Specialist

pdrating@pacbell.net

California Permanent Disability Ratings

WWW.PDRATINGS.COM

Voice: (415)-861-4040

Craig A. Lange

Administrator/Medical Report Tech

craiglange@pacbell.net

Southern California Fax #: (619) 374-7334 Central Valley Fax #: (916) 848-3582 / Bay Area Fax #: (415) 276-3741

The Nuts And Bolts Of The Einstein-Horner Calculation

What To Do When Rating Overlapping Subjective Factors Of Disability

2. For Example: Einstein-Horner Calculation for Basic Pain (Lower Extremities)

a. Constant slight-to-moderate pain with Sustained Weight bearing

E.H. Calculation: Basic Pain: 30%(constant slight-to-moderate) x 20 = 06 » 05 *

b. Occasional slight pain with activities requiring minimal effort (Limitation to Light Work).

E.H. Calculation: Basic Pain: 10%(slight pain) x 50 = 05 x ¼ (occasional) = 1.25 » 01 *

c. Constant moderate pain with Heavy Work would modify the 20% rating standard to a 10% standard.

E.H. Calculation: Basic Pain: 50% x 30 = 15% *

d. Frequent moderate Pain With Repetitive Motions of the neck and spine.

E.H. Calculation: Basic Pain: 40% (Use the Table!) x 15% =06 » 05 % *

· At the end of the calculation the Rating Standard is expressed as one of the following values: 1,2,3,5,8,10,13,15 & multiples of 5% thereafter, before modification for age and occupation.

Rating Schedule-Page 1-13

Work Capacity Functional Loss: One Or Both Lower Extremities Multiple disability factors will have some redundancy in how they affect specific abilities or overall function, and an unrealistic result will be achieved by simply adding factors together. Multiple factors are compacted (scaled down) to avoid duplication and pyramiding. Schedule: Refer to Pages 2-16 to 217, notes 35 to 50 and Page 2-19, notes 1 and 2. On Page 2-16, refer also to Disability # 14 .461 - 80%: Immobility of One Hip Joint requiring the use of Crutch/Crutches.
0	03		05		08			10		13		15		20		25			30		35		40		45		50			55		60		65		70			75		80
			< No Kneeling or Squatting or Crouching											< (A):Climbing, Uneven Ground, Squatting, Kneeling, Crouching, Crawling, Pivoting, Other Similar Activities.
																			< No Heavy Work									Limited to Sedentary Work=
Prolonged Sitting =																			< Repetitive Activities									< Minimal Physical Demands (Light Work)
No Very Heavy Work =																			<No Heavy Lifting and all of (A)
								< No Climbing or Walking Over Un-even Ground																Semi-Sedentary Work =
	< No Running											< No Prolonged Standing											< No Heavy Lifting/Prolonged Weight bearing+(A)
														< No Prolonged weight bearing (75% Standing – 25% Sitting Approximately 25%)
							< No Work At Unprotected Heights																< Limitation to Weight bearing ½ time (50%)
																							< No Sustained Activities of The lower Extremities
Bilateral Lower Extremities - Functional Loss As Expressed By The Disabling Effects Of Pain. Regulation states that subjective factors of disability should be identified by a description of the activity that produces the symptoms. Pain becomes disabling when its degree affects function. Minimal pain is not disabling. However, slight, moderate and severe reflect increasingly greater degrees of disability on work activity.Evaluation Protocols: 8 CCR 46, 9725 & 9727
00		01		02		03			05		08	10	13		15		20			25		30	35		40	45			50		55		60		75		80	90		100
Constant Level of Pain: As Weighted Index of Disability												Constant Slight-to-moderate =																	< Moderate								Severe =
												< Slight														Moderate-To-Severe =
< Minimal/Mild																									< Severe Pain with Substantial Work
												< Severe Pain with Climbing										< Severe Pain with Lifting + all of (A)
Severe Pain: Running =									< Severe Pain with Kneeling									< Severe Pain with Prolonged Weight bearing
Severe Pain with Prolonged Standing =																		< Severe Pain with All Ankle Motion
Severity Key: Minimal (00%) Slight (10%) slight-to-moderate (30%) moderate (50%) moderate-to-severe (75%) Severe (100%)
Frequency Key: Infrequent (1/5) Occasional (1/4) Intermittent (1/2) Frequent (3/4) (4/4) Constant
LPC (06-05-1998)Ó Copyrighted Material No Part Of This Table May Be Reproduced, Reused, Republished Or Transmitted In Any Form, Or Stored In A Data Base Or Retrieval System, Without Written Permission.

Page 4 of 5

Luis Pérez-Cordero

Permanent Disability Rating Specialist

pdrating@pacbell.net

California Permanent Disability Ratings

WWW.PDRATINGS.COM

Voice: (415)-861-4040

Craig A. Lange

Administrator/Medical Report Tech

craiglange@pacbell.net

Southern California Fax #: (619) 374-7334 Central Valley Fax #: (916) 848-3582 / Bay Area Fax #: (415) 276-3741

Einstein-Horner Formulation

Multiple Levels of Pain and Precipitating Activities Example # 1: Constant slight pain that increases to moderate with heavy lifting and to moderate-to-severe intermittently with Heavy Work.
(1) Basic Level of Pain	Constant Slight Pain			10
(2) Next Level of Pain	Moderate			50
(3) Subtract #1 from # 2:	Minus (-)			10
(4) Modify Result by Value Of Activities Precipitating # 2	Heavy Lifting 20%		= 1/5 x	40 = 08
(5) Add Result of # 4 to # 1	10 + 08% = 18% (New Basic Level of Pain)			18
(6) Next Level: Moderate-to-severe Pain	Moderate-To-Severe (75%)			75
(7) Subtract The Result of # 5: (New Basic Level of Pain)			Minus -	-18
(8) Modify Result by Frequency in which # 6 occurs: (Intermittently) = 50%			½	(57)	28.5
(9) Modify Result by % value for activities precipitating the pain – Heavy Work 30%			30% (28.5) = 8.55
(10) Add result of #9 to #5 After rounding, the addition becomes the subjective disability rating standard.		18 + 8.55 = 26.55 = 25%Û		Standard After Rounding: 25%

By Severity/Frequency/Activities Precipitating the Pain Example # 2: Constant slight-to-moderate back pain increasing intermittently to moderate with Very Heavy Lifting
1. Basic Level of Pain	Constant Slight-To-Moderate Back Pain (30%)						30
2. “Highest” level of Pain:		Moderate-To-Severe (75%)					75
3. Subtract #1 from # 2:				Minus -			30
4. Modify # 3 by Frequency in which # 2 occurs: (Intermittently) = 50%					½ X		45		22.5
5. Modify # 4 by % value for activities precipitating the pain – Very Heavy Work 10% X							22.5 = 2.25
6. Add result of #4 (or #5) to # 1, the value for the basic level of pain. The sum of # 1 and # 4 (or #5), after rounding, becomes the subjective factors rating standard before modification for age and occupation			30 + 2.25 = 32.25 Û					Standard After Rounding: 30%
By Activity That Precipitates The Pain Example # 3: Intermittent slight-to-moderate pain with sedentary type activities.
1. Level of Pain	Intermittent Slight-to-Moderate					15
2. Activities Values:	Sedentary Type Activities					70%
3. Multiply # 1 by X 2	15 X 70 =					11
4. Round result of # 3. After rounding, the rating standard becomes the subjective factors rating standard before modification for age and occupation			11 = 10% Û					Standard After Rounding: 10%
ÛThe Resulting standard should be expressed as one of the following values: 1,2,3,5,8,10,13,15 & multiples of 5% thereafter, before modification for age and occupation. (See Page 1-13 of The Schedule.)
Avoid Compounding Of Disability - Incomplete Descriptions Incomplete When The Description Is Only By Severity And Frequency 1. The “Einstein-Horner Formula” is a valid mathematical process, but must only be used when subjective disability has been properly described by the qualifying factors of 8 CCR 9727. 2. Great caution should be exerted in the use of this formulation when calculating a rating standard for an incomplete description of subjective factors of disability since this is contrary to procedures established by the California Code of Regulations and the result is a compounding of disability. 3. Without the proper description of the activities that produces an increased level of pain, it must be assumed that pain increases with all activities.

Luis Pérez-Cordero, MA, AAPMR

Permanent Disability Rating Specialist

Tuesday, November 18, 2003

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