Independent Medical Examination

Dear Dr.:

is the authorized representative of in all of its workers' compensation matters. The purpose of this file review is to determine whether the alleged condition of lumbar sprain is causally related to the claimant's work activities.

This claim has been allowed by the BWC for a sprain lumbar region following the claimant's allegations that he felt back pain after slipping on ice while opening a gate at work. The claimant presented himself to St. Vincent Charity Hospital later that day complaining of sharp pain more on the right than on the left. The claimant admitted to prior back injuries and frequent chiropractic manipulations by a chiropractor during the examination, but was unsure of his previous diagnosis. The claimant stated that his back "has never been great, and I've always had problems with it". On examination, Dr, Daniel Ryu found mild to moderate right paralumbar tenderness. The claimant was diagnosed with a lumbar sprain and given medications. The claimant followed up on March 9, 2005 with Dr. Ryu, reporting minimal improvement. At this examination, the claimant stated that he had a history of multi-level degenerative disk disease in the lumbar spine. Dr. Ryu requested an MRI, which was administered on March 7, 2005 by Dr. Shockley. The MRI revealed severe degenerative disc disease and mild to moderate facet disease at all levels of the lumbar spine. On March 18, 2005, the claimant returned to St. Vincent Charity Occupational Medicine, stating that he was feeling "better", and had been participating in physical therapy.

The BWC allowed the claim for a "Sprain Lumbar Region" on March 9, 2005. The employer does not believe that the claimant's current condition is a result of a workplace incident. The claimant has a history of severe degenerative disc disease in the lumbar spine and frequent chiropractic manipulations. The employer believes that the claimant's current complaints stem from the severe degenerative disc disease and is unrelated to the claimant's 3/1/05 work activities.

Based on this letter and your review of the enclosed medical documentation, kindly provide your opinion to a reasonable degree of medical certainty as to the following questions:

1. Please state your opinion as to whether the claimant's current condition of "Sprain