In assessing impairment, the examiner needs to determine what “loss, loss of use, or derangement of any body part, organ system, or organ function” (5th ed, 2) resulted from the subject injury or illness. However, the rating physician must avoid “double dipping,” ie, rating the same impairment twice. The Guides explains in Section 2.5b, Combining Impairment Ratings, “Related but separate conditions are rated separately and impairment ratings are combined unless criteria for the second impairment are included in the primary impairment” (5th ed, 19).

For example, it is inappropriate for an examiner who is rating spinal impairment and using a diagnosis-related estimates (DRE) category to award an additional 3% whole person impairment (WPI) beyond the baseline rating for the category due to limitation in activities of daily living (ADLs), presumably due at least in part to residual pain,...

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