Injustice for Chronic Regional Pain Syndrome Victim

Calbom & Schwab just finished a Board of Industrial Insurance Appeals case on the topic of Chronic Regional Pain Syndrome (CRPS).

The Department of Labor and Industries (Department) medical examiner concluded that while he, the medical examiner, clearly believed the worker suffered from intolerable pain due to CRPS, and that the injured worker had a large impairment rating (approximately 60%), he was told by the Department that he “should” use Table 13.13 of the AMA guidelines to rate the worker’s impairment (the table for rating CRPS). However, Table 13 required finding a larger number of medical findings to establish CRPS than existed in the client. As she did not have all the required findings under the AMA Guides to Impairment Ratings (5th edition) under Table 13 for CRPS, the argument the Department was using was that she did not have CRPS and must have 0% impairment; yet the Department examiners (there were two but only one testified) said she clearly had CRPS despite failing to satisfy the AMA guidelines.

It is worth noting that other than the discussion in the AMA Guidelines referenced above, there are reputable associations that have established diagnostic criteria or guidelines for making a CRPS diagnosis, and the worker satisfied those diagnostic criteria of such associations as agreed to by both the Department examiner and the medical examiner retained by my office.

The failure of the Department in this case was to recognize that the AMA guidelines have never been set up as the diagnostic criteria for CRPS, but is simply a tool for bringing consistency in establishing percentages of impairment ratings for various conditions, including conditions that are not well described under the AMA Guidelines. The AMA Guidelines recognize that not all conditions are well described in its system, and, if not, one is to select that rating that best describes the injured person’s impairment.

The position of the Department was absurd for if she did not satisfy Table 13, she had a clear impairment that could easily be rated under Table 16, and this was admitted to by the Department examiner; yet using Table 16 was objected to by the Department.  The Department said the examiner “should” use Table 13 only. The Department examiner said he felt “pressured” to reach the absurd result of saying she had 0% impairment because the Department said if the examiner’s diagnosis was CRPS she had to be rated under Table 13, not Table 16.  The Department never resolved the lack of logic in its position.

She had a clear impairment according to the Department examiners, so the order, by the Department should not have been to limit to examiners to Table 13, but to look elsewhere in the AMA Guidelines to see if there was another table, such as Table 16 that would allow her disability to be rated; in fact, the AMA Guidelines state that this is how one should proceed.

This was an injustice to the client who had to spend the money in costs and attorney fees to fight for what she should have been entitled to without litigation, a rating under Table 16 at a minimum.

Pending decision, but the Department examiner testimony makes an unfavorable outcome unlikely. We will update.