Spinal impairment rating is performed using one of two methods: the diagnosis-related estimate (DRE) or range-of-motion(ROM) method.


The DRE method is the principal methodology used to evaluate an individual who has had a distinct injury. When the cause of the impairment is not easily determined and if the impairment can be well characterized by the DRE method, the evaluator should use the DRE method.


The ROM method is used in several situations:

  1. When an impairment is not caused by an injury, if the cause of the condition is uncertain and the DRE method does not apply, or an individual cannot be easily categorized in a DRE class. It is acknowledged that the cause of impairment (injury, illness, or aging) cannot always be determined. The reason for using the ROM method under these circumstances must be carefully supported in writing.
  2. When there is multilevel involvement in the same spinal region (eg, fractures at multiple levels, disk herniations, or stenosis with radiculopathy at multiple levels or bilaterally).
  3. Where there is alteration of motion segment integrity (eg, fusions) at multiple levels in the same spinal region, unless there is involvement of the corticospinal tract (then use the DRE method for corticospinal tract involvement).
  4. Where there is recurrent radiculopathy caused by a new (recurrent) disk herniation or a recurrent injury in the same spinal region.
  5. Where there are multiple episodes of other pathology producing alteration of motion segment integrity and/or radiculopathy.

The ROM method can also be used if statutorily mandated in a particular jurisdiction.


In the small number of instances in which the ROM and DRE methods can both be used, evaluate the individual with both methods and award the higher rating.

A flowchart of the spine impairment evaluation process is provided in Figure 15-4.


Summary of Specific Procedures and Directions

  1. Take a careful history, perform a thorough medical examination, and review all pertinent records and studies. This is helpful in determining the presence or absence of structural abnormalities,
  2. nerve root or cord involvement, and motion segment integrity.
  3. Consider the permanency of the impairment, referring to Guides Chapter 1 and the Glossary for definitions as needed. If the impairment is resolving, changing, unstable, or expected to change significantly with or without medical treatment within 12 months, it is not considered a permanent (stable) impairment and should not be rated under the Guides criteria.
  4. Select the region that is primarily involved (ie, the lumbar, cervical, or thoracic spine) and identify the individual’s most serious objective findings. Determine whether the individual has multilevel involvement or multiple recurrences/occasions within the same region of the spine. Use the ROM method if:
    1. there are fractures at more than one level in a spinal region,
    2. there is radiculopathy bilaterally or at multiple levels in the same spinal region,
    3. there is multilevel motion segment alteration (such as a multilevel fusion) in the same spinal region, or
    4. there is recurrent disk herniation or stenosis with radiculopathy at the same or a different level in the same spinal region; in this case, combine the ratings using the ROM method
  5. If the individual does not have multilevel involvement or multiple recurrences/occasions and an injury occurred, determine the proper DRE category. Most ratings will fall into categories I, II, or III. A corticospinal tract injury is evaluated according to Section 15.7.
  6. If the individual has been treated with surgery or another modality, evaluate the results, extent of improvement, and impact on the ability to perform activities of daily living. If residual symptoms or objective findings impact the ability to perform ADL despite treatment, the higher percentage in each range should be assigned. If an individual had a prior condition, was asymptomatic, and now—at MMI—has symptoms that impact the ability to perform activities of daily living, the higher rating within a range may also be used. If ratings are increased, explicit documentation of the reasons for the increase should be included in the report.
  7. If more than one spine region is impaired, determine the impairment of the other region(s) with the DRE method. Combine the regional impairments using the Combined Values Chart (p. 604) to express the individual’s total spine impairment.
  8. From historical information and previously compiled medical data, determine if there was a preexisting impairment. Congenital, developmental, and other preexisting conditions may be differentiated from those attributable to the injury or illness by examining preinjury roentgenograms or by performing a bone scan after the onset of the condition.
  9. If requested, apportion findings to the current or prior condition, following jurisdiction practices and assuming adequate information is available on the prior condition. In some instances, to apportion ratings, the percent impairment due to previous findings can simply be subtracted from the percent based on the current findings. Ideally, use the same method to compare the individual’s prior and present conditions. If the ROM method has been used previously, it must be used again. If the previous evaluation was based on the DRE method and the individual now is evaluated with the ROM method, and prior ROM measurements do not exist to calculate a ROM impairment rating, the previous DRE percent can be subtracted from the ROM ratings. Because there are two methods and complete data may not exist on an earlier assessment, the apportionment calculation may be a less than ideal estimate.
  10. For individuals with corticospinal tract involvement, refer to Table 15-6 for the appropriate impairment rating.