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7.4 Assessment of spinal injuries and associated limb impairment
Medical evidence supports the understanding that lumbar spine disease, including degenerative joint diseases such as lumbar spondylosis, impacts lower limb function.
Essentially, the courts have argued that it is important to recognise that some conditions will affect more than one body part/system and may require consideration/assessment under more than one table and/or chapter.
Based on medical evidence and judicial consideration, the same rationale can been adopted for the assessment of cervical spine injuries and the associated impairment that impacts upper limb function. Functional outcomes such as difficulty with grasping and holding and no digital dexterity can be direct outcomes of a cervical spine injury or disease.
For example, if a person suffers from lumbar spine disease as a result of their service in 1976, the condition will be under the 1971 Act. Where medical evidence provided supports that the client suffers from lumbar spine disease which also has an impact on the lower limb function, it could be considered that the impairment to the lower limb function which became permanent prior to the commencement of DRCA is assessable under the 1971 Act Table of Maims.
Therefore if the person suffers a loss specified under section 39 of the Act, such as a loss of efficient use of the leg at or above knee (or leg below the knee) as a result of their back condition, there would be some lump-sum compensation payable to the person. We are in effect, saying that impairment to the lower limbs exists because of the back injury. Of course, back conditions are not listed on the table of maims under either of the 1930 or 1971 Acts, so compensation would remain unpayable for any impairment to the back.
Delegates are always reminded to be particularly mindful of applying this when the effect of a spinal condition on limb function is supported with appropriate medical evidence from the clients treating or assessing medical practitioner. Therefore, if there is medical evidence to support that there is a loss, or loss of efficient use covered by one of the limb tables as a result of a spine condition, then an impairment rating can be assigned and the person compensated accordingly.
Importantly, where we are compensating a limb impairment as a result of an accepted back condition, and the evidence indicates that the entire leg is effected, we should be using one ‘above the knee’ rating (up to 75%), and not both an above the knee and below the knee rating.