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Thread Title: Pain add -Guides
Created On Thursday August 30, 2007 3:04 PM

denyse
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Thursday August 30, 2007 3:04 PM

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Thought I would post here also:

Anyone have any feedback on how the DEU is reviewing unsubstaniated pain add ons (DRE or add on under chapters 3-14 and 16-17)? Some aren't worth fighting but I have seen many that are (Lumbar DRE II- 8% + a 3 pain add on). That's 6 points after FEC is 8%, and it goes up exponentially the higher the WPI start point. Be interesting to see what happens at a file review with sophisticated ER/consultant if IC/TPA never refutes.

m&fs
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Thursday January 17, 2008 7:47 AM

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I have found that this passage from the Master the AMA Guides p. 282 is helpful:
"note that if an individual is given a discretionary impairment award based on concepts in another chapter of the Guides (eg, Chaptr 15 on impairment of the spine), the examiner should not give a second discretionary award based on the individuals pain. For example, Chpt 15, Example 15-4(p. 386), describes diagnosis-related estimate (DRE) lumbar category III with a range of 10% to 13% WPI. If an individual is rated category III and a CIR of 13%WPI is assigned on the basis of pain and difficulty in performing ADL, then an additional discretionary 3% should not be assigned because of the individuals PRI." (Master, p. 282 top paragraph)

inkwell6
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Friday January 18, 2008 2:22 PM

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Take a look at the 2005 PDRS pg 1-12. It doesn't limit applying the 3 WP pain add to any body part or system.

Edited: Sunday January 20, 2008 at 10:34 AM by inkwell6

Istok
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Tuesday February 26, 2008 12:49 PM

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Pain is added to the top of DRE categories, period. Nothing you can do about it.
I know, I know it makes someone complaining of unverified radicular pain eligible for 11% with a liberal applicant doctor but what can you do.
Consider it just one of those things that can be abused but when you compare it to rating subjectives in the old schedule it is minuscule.

denyse
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Friday March 14, 2008 8:07 AM

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I agree with the page 282 cite by m&fs. Masters is authored by same people that wrote the Guides. On a pure sensibility take, the DRE can be increased for unresolved symptomatology that impacts ADL. What would stop one from performing an ADL? Pain. As such, an addtional 3% would be duplicative. I suppose if this was to sustain a challenge you might want to get the doctor to clarify why he is giving the DRE increase and why is he giving the pain add on.

On a legal matter, this goes back to a recent issue in the AMA Gudies forum. If the doctor provides no explanation, shouldn't the issue be invalid? Or does one have the duty to defend a defective opinion?

straightshooter
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Monday June 30, 2008 1:08 PM

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The pain add-on is for pain above and beyond what is expected for that condition. What I usually do is determine if patient deserves the higher range according to the impact on his ADLs and then determine if he warrants a pain add-on if he is also taking unusual amounts of pain medication or being managed by a pain mangement MD. If neither is the case the claimant may warrant the higher range for his ADLs impacted but not a pain add on if he is not taking narcotics. You can't give him the higher range fbecuase his ADls are impacted and then give him pain add-on because his adl's are really impacted. that's double dipping

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danpelin
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Monday July 14, 2008 9:48 AM

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I think that when you have the medical legal evaluator adding the 3% add on for pain, if the cost-benefit analysis dictates, I would recommend taking the applicant's deposition. You may be able to obtain testimony from the applicant that after taking pain medication that he is able to do his ADLs or that his pain substantially lowers after taking medication.

Michaelb
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Monday July 14, 2008 11:17 AM

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There is further discussion on this thread

http://www.workcompforums.com/ca/pro/messageview.cfm?catid=21&threadid=4802

DrMo
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Monday July 21, 2008 7:55 AM

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To all,
The support for the 3 % add on is clearly set in Guides. One must however go to the ERRATA. Figure 18-1 page 574- "Algorithm for Rating Pain related Impairment in conditions Associated with Conventionally Ratable Impairment. Go to Box Viib. The language there reads.
" Pain-related impairment increases the burden of illness slightly, award the percentage impairment found in Step I PLUS a discretionary allowance of 1%, 2% or 3%."

Yours,
Dr. MO

Michaelb
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Friday January 16, 2009 12:48 PM

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The DEU feels pain add on to DRE can be appropriate

http://www.dir.ca.gov/dwc/educonf15/PDRS/Rating.pdf

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