Permanent Impairment Ratings – The Final Report

For some doctors, the world of impairment ratings creates fear and anxiety.Or, on the other end of the spectrum, an adrenaline surge, and battle-ready emotions. Little is taught in most chiropractic colleges on impairment ratings and how they impact the life of a patient and reflect on the competence of the DC caring for the injured patient. This series of blogs will not only help you get in the game but will give you the tools to stay at the top of your game for years to come. If you have not read Part 1, Part 2, and Part 3 of this series, you are going to want to go back before you read this final installment on getting in the game of permanent impairment reports.

The next step is to assemble the information and the assessment into the radiology report. Clearly describing the findings of the translational or angular measurements and if they are ratable are critical to having the person reading the report be able to understand what it means. A chart or grid listing if the various segmental levels are normal, abnormal, or ratable helps the reader get an easy understanding.  Using colors such as red to designate something abnormal helps visualize something is wrong with the patient and that the measurement is important to note. Having schematic diagrams or graphics to demonstrate how the measurement was obtained or how the ligament can be injured in a retrolisthesis or anterolisthesis measurement is helpful in some cases. Plus, including into the body of the report an image of the actual flexion/extension x-rays with line drawings being demonstrated and the measurement annotated add to the visual impact of evidence.

When you get to the radiology report impressions and conclusions section you will need to select a number; a single number; not a range, based on the respective 5th or 6th Edition AMA Guides to apply a rating. For the sake of this article, there is a lot more that goes into a whole person impairment (WPI) if you are assessing other body parts and other injuries separate from the AOMSI component, but we will assume that AOMSI is the only portion we are assessing and rating, which leads us to a simplified selection from the impairment tables for the various spine regions.

For example, an AOMSI of greater than 3.5 mm at one level of the cervical spine would garner an impairment rating of minimally 25% WPI. (5thEdition, page 392, Table 15-5). That rating is significant.  In the 6th Edition, only one vertebral motor unit level of AOMSI equates to an impairment of somewhere between 4% and 14% depending on radiculopathy findings and other history, examination, and clinical testing results. If it were 2 or more segmental levels of AOMSI it would elevate to 15% to 30% depending on clinical radiculopathy and other findings. (6thEdition, page 564, table 17-2.) You cannot give a range of percentages for WPI, it must be a specific number within the range. The purpose of our discussion on AOMSI is not to describe the entire AMA Guides for impairment, but to show how just one section using AOMSI can be used by itself to demonstrate impairment.

Using references of published literature papers in your report is valuable in adding further credibility. You have relied on The AMA Guides and other peer reviewed published literature, as well as your clinical experience and expertise combined with the patient clinical presentation. Document the patient’s agreementand desire to have you perform the impairment rating demonstrating theirpreference for this evaluation to be performed.

The final step after creating the professional radiology report in a format that is easily digestible and understood, is to present the report to the patient, the attorney, and possibly the claim adjuster.

Being confident and authoritative is critical to your success. There is no need to be bashful about following The AMA Guides and the customized report generated with assistance from software with your personalized commentary added. Being factual and to the point in a succinct manner wins the day. That means a satisfied attorney that refers more cases to you, a relieved patient knowing you are applying scientific, validated, and standardized measurements that are accepted in courts across the country.

The information may seem overwheling if you have never performed an impairment rating. I can assure you that after having testified in court on 32 personal injury cases and over 90 depositions, it gets easier each time as long as you prepare and keep it simple. That’s why a detailed radiology report allows you to explain AOMSI findings in a court room because the information is in your hands to refer to. Whether you create your own or rely on a software tool to help generate the AOMSI measurements and the radiology report for you, your added cusotmizations can provide a valuable service that your patient deserves and attorneys love. If you are going to care for personal injury cases, you owe it to them to be knowledgeable on impairment ratings or have a referral relationship with a chiropractic colleauge who will provide the service. DC’s are the perfect spinal heathcare experts to deliver this service.


  1. TheAMA Guides, 5th Edition, page 378.
  2. The AMA Guides, 6th Edition, page 578.



Image 1: Translation Method for AOMSI Determination using the AB ratio in AMA Guides 6th Edition



Image 2: Anterolisthesis Image indicating ligament injury.



Image 3: Translationmethod in AMA 5th Edition measuring anterolisthesis.



Image 4: Angulation measurement method for AOMSI (greater than 11 degrees is ratable).


Permanent Impairment Ratings:

  1. Get in the Game
  2. Follow the Guides
  3. The Delivery
  4. The Final Report

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