Impairment to knee based on arthritis (California)

[rosellavera]

IW developed pain in her right knee. X-rays show a 3mm medial joint line on the right, normal on the left. There is mild patellar spurring bilaterally. There is no evidence of a new or old fractureor dislocation. No soft tissue calcification is noted. The overall osseous density is satisfactory. AME gives 7% WPI for arthritis using chapter 17, pp 544-545 (Table 17:31) At the bottom of Table 17:31 it states "In an individual with a history of direct trauma, a complaint of patellofemoral pain and crepitation on physical examination, but without joint space narrowing on x-rays, a 2% whole person impairment or a 5% lower extremity is given." My question is how did the AME arrive at the 7% WPI to the right LE?

[denyse]

He is wrong. 12% LE (x .40 = 5% WPI). That's only if there was direct trauma. If not, can't use footnote - just 3% WPI. Issue in Blackledge case.

[zacko1]

I read your post as saying the doctor found a cartilage interval of 3 mm on the medial side of the knee. If so, it seems possible that the doctor was using Table 17-31 and trying to assign impairment based on a 3 mm cartilage interval. The lower extremity impairment for such a finding is a 7% lower extremity impairment, resulting in a 3% WPI. It seemd possible that the doctor simply recorded the lower extremity % instead of the WPI, and that the correct WPI is 3%.

[denyse]

Wouldn't be the first time.

[ama andy]

Reviewing this it seems pretty straight forward. The cartilage interval of 3 mm equates to a 7 LE or 3 WP impairment. Doctor just put down the wrong index. If the report were submitted to DEU the correction would be made. To make sure to cross every t and dot every i, the claims administrator should obtain a supplemental report. No need to debate the footnote on Table 17-31.Anyone what to take a crack at what "direct trauma" is defined as?

Thanks Zacko1 for your response.

[ozzie]

I'll ask: what is "direct trauma?" Would that not mean a blow of some sort, rather than a twisting motion, or some other form of trauma?

[rosellavera]

I think it means a specific injury rather than a CT.

[ama andy]

The word "direct" means pertaining too, proceeding without interuption, having no intervening cause.Trauma comes from the Greek and means "wound" or "injury."I have also been around workers' compensation long enough to remember when cumulative trauma injury was referred to repetitive microtrauma. In the Blackledge case, the rater tried, unsuccessfully, to substitute his lay judgment for the physician as to whether there was direct trauma to the knee.

My point is that the bar for "direct trauma" is pretty low. About all the doctor needs is a knee injury to assert that this criterion has been met and it is the doctor's call. I believe that the defense asserting that a direct trauma must be a direct blow on the knee cap rather than a twisting injury is not a winning argument. Neither do I believe that direct trauma is a differentiation between a specific and a cumulative trauma injury.

One should keep in mind that there are three criteria that must be in place for the footnote on Table 17-31 to apply - direct trauma, pain and crepitation. Also, this is an arthritis impairment table so those three criteria should signify the beginning of arthritis that cannot yet be measured by cartilage interval.

Of course as the defense you can assert what you wish, just remember to reserve your case properly.