OUR MEDICOLEGAL SERVICES:
BILLING AND GENERAL CONSIDERATIONS
Imaging is vital to my assessment of most cases, and I can access
most studies on-line. For almost any study in Rhode Island, and
many in Massachusetts, I can obtain them myself at no additional
charge with authorization to do so. Images will be analyzed, selected,
and inserted into the reports as appropriate. Imaging CDs sent with
records will be returned if requested. We no longer accept imaging
I can currently
access imaging from the following networks. Given HIPAA constraints,
I will need permission (via e-mail is fine) from either you, the
claimant, or the claimant's attorney.
Radiology (Rhode Island)
(Fatima and RWMC)
MRI of New England
Island Medical Imaging
Deaconess Hospital (hopefully in near future)
MEDICAL EXAMINATION (IME): Please
note that we do IMEs both in MA and RI. These are charged at a flat
rate of $990.00. This includes all transcription costs, imaging
review, report, and a teleconference if desired. As a courtesy,
I will review limited medical records that arrive on or before the
day of the IME. "Limited" is defined as less than 100
pages of medical records (including cover letter, dividers, etc.)
and an unlimited number imaging studies. If additional records or
imaging studies arrive after the day of the IME, they will be reviewed
at a rate of $800.00 per hour.
My charge for a court or arbitration appearance is $8,300. I
block off an entire day for these. In the event of the need for
travel, relevant costs (airline ticket, food, etc.) will be billed
in addition. We will not assign time for these until full payment
has been received. My preference is to appear at trial instead of
undergoing an audiovisual deposition. I have arranged my schedule
such that I am available on most Mondays, Tuesdays and Fridays for
This is charged at a rate of $990.00 per hour, with a minimum charge
of 2 hours. This includes review of any limited additional records
and additional imaging studies provided for that meeting (see definition
of "limited" above). We request full payment in advance.
The majority of my consultations involve record reviews, and the
rates are below. It is entirely based on the number of pages.
pages with IME
The report will
usually arrive via e-mail within 10 business days of receipt. Please
bear in mind that my clinical responsibilities are foremost, and
if patient care needs require more of my time, it may take longer.
If you have deadlines such as an arbitration or statute of limitations,
please let us know and we will be able to accommodate you. The report
will be fully annotated and referenced, and any pertinent imaging
will be pasted into the text of the document. The rate above includes
review of an unlimited number of imaging CDs, and a 30-minute teleconference
if desired. Please never hesitate to email me if a report is late
For an urgent
review, an additional 25% will be added. "Urgent" is defined
as a completed review within 5 business days of my receipt of the
OF DOCUMENTS: I am often not informed when cases are dismissed
or settled. If I have not received correspondence regarding a case
for 4 years after the time I have submitted my report, I will destroy
FROM AN ATTORNEY OR FIRM: For a first time referral, payment
will be required on receipt of the documents to be reviewed.
SITE ASSESSMENTS: Please
note that the above fees are for evaluation of EITHER the neck/back
OR head. If both a spinal and head (see below) evaluation are required,
due to the increased work that this involves, a 20% increased fee
will be applied. This may differ from the original estimate.
includes closed head injuries, minimal traumatic brain injuries
(mTBI), concussions, and post-concussion syndrome.
INVOLVEMENT IN CASES
I have reviewed
medicolegal cases for over 20 years. I have not refused to give
my opinion on a case, and will continue that policy. However, referring
adjusters or attorneys should be made aware of certain instances
when I will not provide testimony against a physician.
- When a doctor
who is being sued is a personal friend or someone with whom I
- When a doctor
has made a mistake that was outside the standard of care, but
the patient was not injured in any significant way as a result.
Example: Doctor Jones operates at the wrong level of the lumbar
spine during a microdiscectomy. A small opening is made microscopically
into the lumbar spinal canal, and then closed. This mistake is
later recognized, and a short time thereafter the operation is
performed at the correct level. The patient claims chronic back
pain afterward. I would not help in such a case as a microscopic
canal opening and nerve inspection causes no meaningful long-term
damages such as back pain.
- When a doctor
did not make a mistake, but I am asked to render an opinion in
regard to causation only. Example: Doctor Smith sees a patient
with non-specific symptoms that, only in retrospect, turned out
to be the first indications of a brain tumor. The patient undergoes
surgery years later and does poorly. In this instance, I might
be asked if the patient would have done better if the diagnosis
had been made earlier, and if the operation had been performed
sooner. While the answer to that is yes, I would not help in such
a case as Doctor Smith had treated the patient within the standard
We have been
experiencing a large number of last minute cancellations and postponements.
Many claimants do not show with no forewarning. While we understand
the difficulties involved with your scheduling these, and appreciate
your involving us in them, we book these months in advance. We move
operations and clinics to accommodate them.
or postponement of IMEs, depositions, and court appearances with
more than 7 business days' notice: A full refund will be
Cancellation or postponement of all scheduled legal
appointments with less than 7 business days' notice: No refund
will be returned.
KEEPING: There has been a remarkable amount of change
in the transmission and maintenance of medical records over the
past several years. We now receive imaging studies and other records
by paper, CD, flash drive, or link to repository, e.g. DropBox.
Our current policy is to maintain paper documents for 4 years.
For example, any case we receive in 2018 will be destroyed in
January of 2022. Imaging studies and surveillance video sent to
us on CD, DVD, or flash drive, or film will be analyzed, and pertinent
images pasted into the medical report. They will then be destroyed
unless we are asked to return them.
NOTIFICATION: We check our email several times per day. In
addition to the option of calling our office (401 453-3545), please
send email notice to the below addresses with a return receipt
FOR SERVICES - We are spending increasing amounts of
effort and time collecting fees for our services. If we have not
received payment 2 months (60 days) after you receive our report
and invoice, we will add a surcharge of 1.5% per month.
appreciate your understanding and cooperation. A copy of this policy
will be faxed or emailed to your office at the time of scheduling.
Sample record review performed by Dr. Saris below -
MEDICAL EVALUATION ON MICHAEL SMITH
CHIEF COMPLAINT: Michael is a 61-year-old man
referred for medical evaluation.
HISTORY: This middle-aged man was well until over four years
ago when he claims he was injured seriously at work. A roughly 600-pound
piece of equipment began to fall, and in attempting to stop it from
doing so, he developed acute low back pain. This was treated by
Dr. Jones. Although much improved compared to before the surgery,
he continues to have pain and other problems at this time.
Prior to this accident, he had never undergone lumbar imaging.
He had never been to a healthcare provider for back problems. The
pain began to hurt immediately, and has gotten better over time
(with the surgery of Dr. Jones). The pain is primarily axial in
the back, though it travels down both hips and then diffusely into
the thighs, legs, and feet. The majority of the pain is axial and
to the right side of the midline. The pain is constant, and is both
moderate-to-severe. He has no comfortable position. It hurts both
at rest and with activity, but is worse with activity.
He has undergone physical therapy that was somewhat helpful. He
has not been to a chiropractor. He has undergone no spinal injections.
He currently takes both tramadol and oxycodone for discomfort.
He was out of work for about two years, but has currently returned.
He is not capable of physically demanding activity due to his back
discomfort. He is independent at home and can drive a car, though
he fails for longer distances.
I asked him about his hip pain, and he says that the right hurts
more than his left. He was very clear that the hip pain did not
start until two years after the 2013 accident (sometime in 2015).
This pain hurts at all times, and he has no comfortable position.
He is currently back working in a carpentry setting. He no longer
does the heavy physical labor, but does supervisory work.
He takes less than one narcotic tablet per day, and estimates 2
hydrocodone or 2 oxycodone tablets a week. He takes daily tramadol.
PERSONAL HISTORY: He is married, and has three children.
FAMILY HISTORY: His parents are both deceased.
DRUG ALLERGIES: None.
HABITS: He neither drinks nor smokes.
CURRENT MEDICATIONS: Tramadol and oxycodone.
REVIEW OF SYSTEMS: Poor exercise tolerance, painful joints,
neck pain, back pain, poor muscle strength, arm weakness, leg weakness.
The patient denied high blood pressure, arthritis, abdominal pain,
abdominal swelling, black, tarry bowel movements; change in bowel
habits, constipation, cirrhosis of the liver, cramps, diarrhea,
gallstones, heartburn, hemorrhoids, hepatitis, indigestion, nausea,
passing of blood from rectum, stomach or duodenal ulcer, vomiting,
vomiting of blood. EARS: The patient denied drainage from
ear, ear pain, or sinus trouble. GENITOURINARY: The patient
denied blood in urine, difficulty controlling urine, difficulty
passing urine, kidney stones, pain or burning while urinating. NEUROLOGICAL:
The patient denied blurred vision, buzzing, or ringing in ears,
difficulty with balance, difficulty with hearing or deafness, difficulty
swallowing, dizzy spells, double vision, fainting spells, light
flashes, memory loss, persistent hoarseness, severe headaches, speech
difficulty, or stiffness. SKIN: The patient denied changing
or bleeding moles, or rash. NECK: The patient denied neck
stiffness, or new unexplained lumps. BONES & JOINTS:
The patient denied polio, rheumatic fever, or swollen joints. CHEST,
HEART, LUNGS: The patient denied abnormal chest x-ray, abnormal
electrocardiogram, chest pain, enlarged heart, angina, coughing
up blood, fluttering of the heart, frequent cough, heart attack,
heart murmur as an adult, shortness of breath, unusual heartbeat,
varicose veins, wheezing. ENDOCRINE: The patient denied coldness
most of the time, diabetes, goiter, gout, night sweats, overactive
thyroid, poor exercise tolerance, thirstiness, underactive thyroid,
unusual fatigue or sluggishness, unusual jumpiness or nervousness,
or warmness most of the time. PSYCHOLOGICAL PROBLEMS: The
patient denied serious depression and made no mention of any serious
psychiatric disorder. HEMATOLOGIC: The patient denied easy
bruising, nosebleeds not due to injuries, poor blood clotting, swollen
glands, unexplained fevers, chills.
PRIOR SURGICAL HISTORY: Back surgery in August 2013. 1
He is an unusually pleasant and likeable man, who comes in by himself.
Vital signs and measurements were: Height 6 feet 0 inches, weight
205 pounds, heart rate 80, respirations 16, blood pressure 130/72.
GENERAL MEDICAL ASSESSMENT:
Carotid artery examination revealed no evidence of bruit or other
abnormality. Heart rhythm was normal without extra sounds or murmurs.
There was no abnormality of the peripheral vascular system and the
right radial pulse was strong. Breath sounds were clear without
rales, rhonchi, or wheezes. The abdomen was soft and non-tender.
No masses were palpated.
Mental status exam was normal. Orientation was normal, and memory
was intact. Attention span and concentration were normal. Receptive
and expressive speech was normal. Fund of knowledge was normal.
Cranial nerve II: To confrontational
testing, there was no peripheral field abnormality. Visual acuity
was intact to reading small print.
Cranial nerve III, IV, VI: Extraocular
movements are full without nystagmus.
Cranial nerve V:
Facial sensation is symmetric.
Cranial nerve VII:
Facial movement is symmetric.
Cranial nerve VIII: Hearing
Cranial nerve IX, X: Palate
elevates in the midline.
Cranial nerve XI: Shoulder shrug
is strong bilaterally.
Cranial nerve XII:
Tongue is midline.
Motor exam of the limbs was intact. There was full power and tone,
and no fasciculations or abnormal movements were noted.
UPPER LIMBS: Deltoid power
(C5) was 5/5 bilaterally, brachioradialis power (C5, 6) was 5/5
bilaterally, biceps power (C6) was 5/5 bilaterally, triceps power
(C7) was 5/5 bilaterally, long finger flexors (C8) were 5/5 bilaterally,
and hand intrinsics (C8, T1) power were 5/5 bilaterally.
LOWER LIMBS: Quadriceps power
(L4) was 5/5 bilaterally, anterior tibialis (L4, 5) and extensor
hallucis power (L5) were 5/5 bilaterally, and plantar flexion (S1)
was normal bilaterally.
1 He gave me written and verbal permission
to review any medical records that are obtainable online.
Sensory examination with a pinwheel was unremarkable with no focal
deficit in a peripheral nerve or root distribution. Reflexes were
normal and symmetric in the upper and lower limbs.
Examination of the neck was normal. When viewed from the side, the
lordotic curve was normal. Range of motion was full. I carefully
palpated and examined the lumbar musculature that consisted of the
latissimi, quadratus lumborum, and multifidus muscles. There was
no atrophy or fasciculation. There was no abnormality of muscle
tension, and no spasm.
He had three of the five Waddell's signs for the lumbar spine,
namely, positive torso rotation test, positive press test, and excessive
pain on examination of his lumbar spine.
Examination of his back showed parallel and linear well-healed
PAIN DISABILITY QUESTIONNAIRE: 110.
OSWESTRY DISABILITY QUESTIONNAIRE: 35.
PATIENT NARRATIVE: Before leaving the office, a clipboard
and a piece of paper were given with "Please write down everything
you feel we should know about your accident and injuries from it."
I carefully reviewed what was written, and it did not add anything
to either the record review or the narrative I took from the patient.
His only comment was why the numbness in his thighs was not checked.2
TIME IN OFFICE: Arrival at our office was at 1:37pm. He
was seen immediately by our medical assistant, and then me, and
left at 3:09 pm.
2 I checked those with a pinwheel.
| On August 17, 2013, Mr. Smith
claims he was injured seriously (subject accident).
On August 18, 2013, he underwent lumbosacral
x-rays that showed a comminuted compression fracture of L4 with
approximately 25% of loss of height and anterior displacement of
an inferior fragment.
On August 18, 2013, he had pain that was acute. It was located
in the lower back. It began about six days previously and became
worse yesterday after lifting a coke machine. The pain radiated
to the right upper thigh and the left upper thigh. "The problem
was sustained six days ago when going upstairs he slipped and
fell backwards landing on his back on a landing five steps back."
He was seen at Urgent Care Clinic where he complained of rib pain.
The prior day he had lifted a coke machine and had the acute onset
of more pain in his low back. Neurological review of systems was
negative for numbness, tingling, and weakness. Detailed
neurological examination was normal. His
x-rays showed a compression fracture at L4. An MRI showed foraminal
narrowing and abnormal signal in the soft tissues.
The case was discussed with Dr. Jones.
On August 18, 2013, he underwent lumbosacral
MRI at FH. There was mild central stenosis at L4-L5. There was
compression fracture of L4 which had lost 25% of its height.
On August 18, 2013, he underwent LS
x-rays at FH. There was a compression fracture at L4. Additional
imaging with MR and CT was recommended.
On August 20, 2013, he underwent lumbosacral
x-rays at FH. It was compared to an August 18, 2013, study which
was of superior quality.
On August 18, 2013, he underwent an
LS CT at FH. It showed a burst-type fracture of L4 with approximately
25% loss of height. There was mild stenosis at that level. There
were fractures of the 10th and 11th ribs.
On August 18, 2013, he was seen. He is a 56-year-old man who
had fallen six days previously on a flight of stairs landing on
his back. He initially only had low back pain, but the prior day
he was lifting a Coca-Cola machine at work and developed acute
worsening of his low back pain. He was married with two children.
He denied tobacco use and worked as a construction superintendent.
Neurological examination was normal. Neurosurgery
recommended admission for pain control and possible brae fitting.
On August 18, 2013, he underwent LS
CT at FH that showed a L4 fracture.
On August 18, 2013, Dr. Coleman saw him
in the FH ER. He was helping a coworker move a heavy piece of
equipment when he had sudden onset of low back pain. He had no
symptoms or paresthesias. There was no weakness in his legs. LS
MR showed a L4 compression fracture with 25% loss of vertebral
body height. Neurological examination was normal. He will be placed
at bed rest and fitted with an orthotic device.
On August 27, 2013, he underwent a LS CT. There was a slight settling
of L4 from 18 to 16 mm.
On August 27, 2013, Dr. Arns
of the Neurosurgical Service did an initial consultation. He had
been admitted on August 18, 2013, for an L4 burst fracture that
was managed non-operatively with lumbosacral orthosis. He came
in to the emergency room with worsened pain. He believed it occurred
while moving a heavy object on August 17, 2013, and was unrelated
to a fall days previously. He was on OxyContin for pain with increased
leg weakness and numbness. He used a walker and complained of
bilateral foot numbness. He denied saddle anesthesia or sphincter
disturbance. Neurological examination was normal.
He might be a candidate for operative intervention.
On August 28, 2013, Dr. Jones dictated
an operative note. He describes him as a 56-year-old man, who
had a burst fracture after a fall. This was managed conservatively
initially with an orthotic brace. His pain significantly worsened
in spite of narcotics. A follow-up scan showed diminished vertebral
height. He had failed conservative measures, and neurosurgery
On August 28, 2013, a CT shows interval
L3 to L5 fusion with satisfactory hardware alignment. There was
a 6-mm retropulsion with moderate stenosis.
On August 28, 2013, he underwent
an evaluation during a neurosurgical consult by Dr. Risk, a Neurosurgery
Resident. Neurological examination was normal.
On August 31, 2013, a pathology report
from the bone showed no evidence of malignancy.
On September 9, 2013, Dr. Sam dictated a discharge history and
physical. He had undergone an L3 to L5 PPS. He was discharged on several medications including
On October 2, 2013, a final physical therapy note describes his
attending three visits. His diagnosis was a closed fracture without
a spinal cord injury. He had undergone percutaneous pedicle screw
On October 10, 2013, Dr. Jones saw him. His medical course is
described in detail. A biopsy was taken and there was no evidence
of tumor. The procedure had been done for internal stabilization
of his spine that had been weakened by the burst fracture. In
a year or two, the instrumentation might be removed. "At
this time, the patient can go back to work." He could transition
to full duty and do not need a brace.
On November 22, 2013, he underwent a
lumbosacral CT scan at FH. It showed an L3 to L5 fusion with intact
hardware and satisfactory alignment. There was some slight loss
of the L4 vertebral height.
On January 6, 2014, Dr. Jones
saw him. He was four months out from L3 to L5 PPS. The pain was
narcotic dependent and he took oxycodone. Neurological examination was normal. Ongoing conservative measures were recommended.
On March 12, 2014, Dr. Jones saw him. He was six months out from
an L3 to L5 percutaneous pedicle screw stabilization (PPS). He
was in physical therapy. He took Tylenol with Codeine. Neurological examination was normal. He was doing well and would continue with
On April 2, 2014, Dr. Jones saw him. He had undergone a L3 to
L5 percutaneous pedicle screw stabilization for an L4 burst fracture.
He had been undergoing physical therapy.
On May 24, 2014, Dr. Jones saw him. He had seen him many times
since his L4 burst fracture and treated with L3 to L5 percutaneous
pedicle screws. He was doing fairly well after surgery. He had
pain and numbness in both of his feet and requested a disability
letter and return to work. His date of birth was October 26, 1956.
Dr. Jones stated, "at this point, I do not think I can do
that. From the spine fracture and the surgery perspective, I think
he has recovered and there should not be any strict limitations.
The limitations maybe no strenuous activity, no heavy lifting
for the back because subjectively the patient stated he has experiencing
pain after physical therapy or any strenuous physical activity."
He stated that from the surgical perspective, he was doing well
and there was no "strong limitation." He then states
"the patient feels his overall body pain and back pain is
from his age and arthritis." He will be seen on an as needed
On August 15, 2014, he was seen in clinic. There was a question
of a mild peripheral neuropathy. Repeat nerve studies were recommended.
Dr. Mann performed electrodiagnostic studies.
On August 19, 2014, Dr. Pont saw him. He had undergone surgery
for his L4 fracture. EDS showed normal
motor function. He had reduced pin sensation in his
legs. Conservative measures were recommended.
On February 1, 2015,
he had gone back to work on a full-time basis. He had increased
pain and limited endurance due to back discomfort. 15 tablets
of Percocet per month would be allowed. Conservative measures
On April 3, 2016, he had chronic low back pain and had not been
seen for several months. "He has been doing fairly well with
his full work schedule." He had variation of pain throughout
the day and used either tramadol or oxycodone on an as needed
basis. The pain went across the back and to both the hips. He
took one to two oxycodone tablets per week, and one to two tramadol
tablets per day. Neurological examination was normal with intact
sensation. The impression was chronic musculoskeletal pain. Conservative
measures were recommended.
On August 4, 2017, a physiatrist, wrote a letter in regard to
Mr. Smith. The patient complained of daily, but variable low back
pain in association with bilateral leg, thigh, and hip pain. The
right leg was worse than the left. A medical history is detailed
including the accident and his subsequent treatment. He describes
a March 2017 lumbosacral MRI that showed degenerative changes
from L1 to L4. There was progression of degenerative change at
L3-L4 with bilateral narrowing. He further describes a clinic
visit on August 1, 2017, when he claimed that his right hip pain
was getting worse. He had tenderness to palpation of the right
hip adductors. He was married and working full time as a supervisor
for a construction company. His exercise was limited. Neurological
examination showed no focal weakness, though he had subjective
numbness and tingling in his feet. His diagnoses were a prior
fusion and degenerative lumbar changes. He additionally rendered
the diagnosis of chronic hip and buttock musculoskeletal pain.
He related all of these to the subject accident. He was not at
a medical end result. There was evidence of progression of degenerative
changes at L3-L4 and L5-S1. He might require narcotics to sustain
his level of activity. He applied a 23% whole person impairment
according to the fifth version of the American Medical Association
Guidelines.3 His prognosis was
indefinite and had chronic daily pain.
3 I checked those with a pinwheel.
I reviewed the below imaging studies personally.
On August 18, 2013, he underwent a lumbosacral x-rays.
It shows a compression fracture at L4. The alignment is normal.
On August 18, 2013, he underwent a lumbosacral MRI.
The compression fracture seemed at L4 with normal alignment and
increased signal on the STIR sequence. Spinal canal was widely
On August 18, 2013, he underwent a lumbosacral CT
scan in Boston. It shows the compression fracture at L4 with mild
posterior retropulsion. The spinal canal was widely patent. Coronal
views show no clinically significant translation.
On August 28, 2013, he underwent a pedicle screw
fixation from L3 to L5. Instrumentation is in perfect position.
Alignment is normal.
On November 22, 2013, he underwent a lumbosacral
CT scan. It shows the instrumentation in excellent position. There
has been no further progression of the compression fracture at
L4. Alignment is normal.
In March 2017, he underwent a lumbosacral MRI. It
shows a prior L2-4 fusion. Screws are in satisfactory position.
Is no evidence of any left-sided canal or nerve compromise.
On August 18, 2013, he underwent a lumbosacral x-ray.
It shows a moderate L4 compression fracture. Alignment is normal.
There is approximately a one-quarter loss of height.
ASSESSMENT: I have made the below statements to a reasonable
degree of medical certainty.
Mr. Smith is a middle-aged man who was injured seriously years
ago. He suffered an L4 compression fracture that was treated successfully
by Dr. Jones. I have been asked to comment on any injuries he
has suffered, and his current medical condition as a result.
In this area of medicine, the means by which patients
are evaluated are the neurological examination, neuroimaging,
and electrodiagnostic studies when available. These indicate an
excellent recovery form his structural spine injury. These will
be discussed in detail below.
The neurological examination is an important part of this
assessment. He has undergone examinations by two neurosurgeons,
and more recently a physiatrist. All were normal, and showed no
evidence of nerve damage.
Electrodiagnostic studies are also helpful adjuncts in
these assessments. Dr. Pont performed such an assessment in August
2014, and it showed no evidence of motor damage.
Neuroimaging is the most important part of these evaluations.
The compression fracture had worsened, and he underwent an L3-L5
fusion by Dr. Jones on August 28, 2013. He made an excellent recovery.
On October 10, 2013, Dr. Jones recommended that the patient return
to work. He could transition to full duty and would not need a
Mr. Smith has made an excellent recovery from his injury. As
it occurred after an incident at work, causation is established.
It has been capably treated by Dr. Jones. Other records indicate
that he has returned to work and is functioning at a "full
work schedule." He requires daily medication and rare opioids.
According to the sixth version of the American Medical Association
Guidelines, he has a whole person impairment of 4% (see below).
He has minimal functional impairment and minimal disability. He
could return to work activity at the USDOL medium level.5
If other records become available such as healthcare provider
notes, imaging studies, deposition testimony, or video surveillance,
these should be obtained and sent to me for review. If he has
seen Dr. Jones subsequent to May 21, 2014, those notes should
be obtained and sent to me for further review.
Signed under the pains and penalties of perjury, this 31st day
of October, 2017.
Lecturer in Neurosurgery
Harvard Medical School
Brigham & Women's Hospital
4 On May 24, 2014,
Dr. Jones stated "from the spine fracture and the surgery perspective,
I think he has recovered and there should not be any strict limitations.
The limitations maybe no strenuous activity, no heavy lifting
On April 3, 2016, Dr. Montview, a physiatrist, saw him. He had chronic
low back pain and had not been seen for several months. "He
has been doing fairly well with his full work schedule." He
took two oxycodone tablets per week and two tramadol tablets per
5 UNITED STATES DEPARTMENT OF LABOR, DICTIONARY
OF OCCUPATIONAL TITLES, AND JOB CLASSIFICATIONS
MEDIUM WORK: Employee may exert 20 to 50 pounds of force
occasionally (< 1/3rd of the time) and/or 10 to 25 pounds of
force frequently (1/3rd or 2/3rds of the time) and/or greater than
negligible up to 10 pounds of force constantly (> 2/3rds of the
time) to move objects. Physical demand requirements are in excess
to those for light work.
1. (GMFH-CDX) = NA7
2. (GMPE-CDX) = 0
3. (GMCS-CDX) = 0
Net adjustment (sum of above three)= - 2
MODIFIER= 0 =
Grade modifier A
FINAL WHOLE PERSON IMPAIRMENT= 4%
or inconsistent symptoms
symptoms with strenuous/vigorous activity
symptom with normal activity
symptoms with less than normal activity
symptoms at rest, limited to sedentary activity
to the Evaluation of Permanent Impairment,
2008 American Medical Association, Library of Congress
7 "This is 2 or more points higher
than the class assignment and therefore discounted." page 584,
6th version AMA Guidelines
8 Subjective complaints without objective physical
findings or significant clinical abnormalities are generally assigned
class 0 and have no ratable impairment. Page 561 and 575, 6th version