Washington doctors rating permanent impairment of the cervical or cervico-dorsal spine use this two-page worksheet. After confirming maximum medical improvement, aggravation of any pre-existing condition and permanent impairment, the doctor circles one box in each of three columns (nerve root involvement, neck rigidity substantiated by imaging, and range of motion or spasm findings), then averages them into the category rating.
The attending physician or consultant performing the rating completes and signs it, certifying an exam within the last 8 weeks. Under L&I policy, chiropractors must be approved IME examiners to rate impairment.
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Doctor's Worksheet for Rating Cervical and Cervico-Dorsal Impairment
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Circle one box in each of columns A, B and C, add the numbers, divide by 3 and round to the nearest whole number (1.1 becomes 1, 1.5 becomes 2). You can instead copy the circled numbers into the boxes and let L&I do the calculation.
No. Oswestry and other pain scales are not considered. Pain is part of the rating only when it shows up in findings recorded on the worksheet, such as decreased range of motion, which belongs in column C with spasm and other findings.