In the case of Laury vs R&W Concrete, the AME doctor, Dr. Joseph Izzo contended that due to the several back surgeries that the claimant had had, that a rating on the lumbar spine was not appropriate using either the DRE or ROM methods despite the fact that both of these methods are acceptable methods of disability rating.

Dr. Izzo opined that the claimant had lost a substantial portion of the functionality of the lumbar spine. Page 427 in the AMA Guides shows that for the spine the maximum whole person impairments for each section of the spine are 80% WPI for Cervical, 40% for Thoracic, and 90% for the Lumbar. Dr. Izzo rebutted the standard permanent disability rating with an Almaraz/Guzman analysis and determined that the claimant had lost 60% of the functionality of the lumbar spine. Since the lumbar spine maximum WPI is 90% Dr. Izzo took 60% of 90% which resulted in 54%. That was determined to be the whole person impairment. This approximately doubled the client’s WPI.

The WCAB commissioners in their majority opinion stated that the doctor did not go beyond the four corners of the AMA Guides and that Labor code 4660 permits reliance on the entire Guides, including a physician’s use of clinical judgment in deriving an impairment rating in a particular case.