DRE Impairment for Nonverifiable vs. Verifiable Radicular Complaints - Uploaded on 01-13-2015
Before estimating the extent of any impairment, the AMA Guides requires that physicians establish an accurate diagnosis. The primary requirement is the confirmation of the presence or absence of specific pathology and/or loss of organ function.
Increasingly, we have encountered evaluations providing Cervical and Lumbar DRE II Impairment based on insufficient findings, without reporting any clinical elements (muscle spasm, guarding, nonverifiable radicular pain) or medical history (prior history of verifiable radiculopathy) in support of the rated impairment. This trend is contrary to Sections 1.5, 15.1b, 15.3, 15.4 and 15.6 guidelines of the AMA Guides 5th Edition.
The attached Spine Impairment Appendix addresses the issue of non-verifiable vs. verifiable radicular complaints. This Appendix will help you decide if the evaluation you are reviewing meets the minimal requirements for Substantial Medical Evidence in the use of a DRE Category II or a DRE Category III.