Guidelines for the assessment of permanent impairment Version 3

4.7 If a medical assessor is unable to distinguish between two DRE categories then the higher categoryshould be applied and reasons for explained in the report.4.8 At the time of the assessment, no value should be placed on the possibility of the conditionbeing treated either medically or surgically in the future. Subject to 1.22 of these Guidelines,the assessment should be made at the time of interview and examination if the medicalassessor considers the condition to be stable and permanent.4.9 The evaluation should not include any allowance for predicted long-term change. For example, aspinal stenosis syndrome after vertebral fracture, or increased back pain due to osteoarthritis ofsynovial joints after intervertebral disc injury should not be factored in to the impairment evaluation.4.10 All impairments in relation to the spine should be calculated in terms of whole personimpairment and assessed in accordance with this Chapter and Chapter 1 of these Guidelinesand Chapter 3.3 of AMA 4 Guides.4.11 A chart similar to Figure 61 (pp 96 - 97, AMA 4 Guides) can be utilised for a summary of thespinal history.4.12 The assessment should include: a comprehensive accurate history; a review of all pertinent recordsavailable at the assessment; a comprehensive description of the worker’s current symptoms; acareful and thorough physical examination; and all findings of relevant laboratory, imaging,diagnostic and ancillary tests available at the assessment. Imaging findings that are used to supportthe impairment rating should be concordant with symptoms and findings on examination. Themedical assessor should record whether diagnostic tests and radiographs were seen or whether theyrelied on reports.4.13 While imaging and other studies may assist medical assessors in making a diagnosis, it is importantto note that the presence of a morphological variation from what is called ‘normal’ in an imagingstudy in and of itself does not make the diagnosis. Several reports indicate that approximately30% of persons who have never had back pain will have an imaging study that can be interpretedas ‘positive’ for a herniated disc, and 50% or more will have bulging discs. Further, the prevalenceof degenerative changes, bulges and herniations increases with advancing age. To be of diagnosticvalue, imaging findings must be concordant with clinical symptoms and signs. In other words, animaging test is useful to confirm a diagnosis, but an imaging result alone is insufficient to qualify fora DRE category.4.14 The medical assessor should include in the report a description of how the impairment rating wascalculated, with reference to the relevant Tables and/or figures used.WCT Guidelines 1 October 2011 23