What is the technical definition of ‘Impairment’?

impair (v.) l, from Old French empeirier, from Latin impeiorare “make worse.” In reference to driving under the influence of alcohol, first recorded 1951 in Canadian English.

Okay…. But what does Impairment mean in the world of Workers’ Compensation?

If you’re a medical professional who examines injured employees, then impairment means “a loss, loss of use, or derangement.” (That’s straight out of the in the AMA Guides 5th Edition, Chapter 1, page 2.)

An injured worker’s impairment is considered permanent when the injury reaches “maximum medical improvement” or “MMI”.

Maximal medical improvement means the patient’s condition is unlikely to change in one year.

The AMA Guides 5th edition refers to impairment as permanent impairment. Permanent impairment requires evaluation of a physician.

Remember, loss, loss of use, or derangement means a change from normal.

So, let’s take this example: imagine a 27-year-old construction worker who has injured her right shoulder. At MMI, you as a doctor, measure the injured shoulder, which flexes to 160°, and then you measure the uninjured shoulder, which comes out to 180°. Does this patient have impairment?

The answer yes, because the employee has lost 20° of use.

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Understanding Exacerbation versus Aggravation

Exacerbation: from exacerbate. ex·ac·er·bate. iɡˈzasərˌbāt/
verb 1. make (a problem, bad situation, or negative feeling) worse.

Aggravation: from aggravate. ag·gra·vate ˈaɡrəˌvāt/
verb 1. make (a problem, injury, or offense) worse or more serious.

The difference… is confusing. That’s why we’re here to help! In a workers’ compensation context, the difference between exacerbation and aggravation is very significant.
  • Aggravation is a worsening of a pre-existing condition or impairment.
  • Exacerbation is a temporary or transient worsening of a prior condition.
  • The determination between aggravation and exacerbation can only be judged correctly when the employee’s work-related injury is at MMI (maximal medical improvement).

Problem Solving: A 34-year-old female has pre-existing chronic low back pain 5/10. Then, a work injury occurs, and the pain in her back increases to 8/10. Conservative care is provided, and at maximal medical improvement the pain returns to a 5/10.

Has an aggravation or exacerbation occurred?

The answer: Exacerbation, because the employee has returned to her pre-existing condition baseline.

Next time you need to look up this pesky but important difference, simply remember that the determination between aggravation or exacerbation can only be made at MMI.

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