In this article, I am going to discuss the calculation of the impairment rating for a COVID claim. But first, I must, once again, do all that I can do to encourage each of you to get vaccinated. I get that this is a politicized disease process. There are educated health care professionals refusing this intervention; however, after reading numerous articles as to why vaccination should not be pursued, NONE rise to the level of competent, peer-reviewed evidence-based medicine establishing why you should not.  I can not condone passing up getting the vaccine unless there is a specific clinical indication not to.  

Now for the good stuff. As previously reported, COVID can be an accepted compensable injury from a clinical perspective and legal (presumption) perspective. If the diagnosis has been established as a compensable injury, then you need to develop a specific checklist of noted symptoms and actual sequelae of the disease. Track and make note osymptoms, the findings upon physical examination, and the laboratory values reported with the subsequent clinical assessment of the disease process. 

COVID has been linked to brain injury (such as anoxia after pulmonary or cardiac complications, heart disease (atrial fibrillation), pulmonary disease (such as changes associated with pneumonia, congestive heart failure, or pulmonary edema), kidney disease (acute kidney injury, avascular tubular necrosis), and there are some who believe that the disease can cause diabetes. Therefore, when each progress note arrives for review, recording the reported symptoms, taking note of the findings on physical examination, and identifying any laboratory data specific to that organ system, will significantly streamline the impairment rating process and assist in the determination of the final whole person impairment rating. If at the time of maximum medical improvement, a specific organ system has not been identified as being affected by the compensable injury, this aspect should be excluded from the final whole person impairment rating.  

With respect to each involved organ system, extremely specific testing needs to be completed, tracked, and followed. As an example, the question that must be answered relative to a brain injury is outlined in Chapter 4. What specific neurologic functional losses are noted? And more importantly, what objective clinical data supports an injury to the brain responsible for those losses? Issues such as aphasia (or other communication disturbances) are an impairable event. Again, what level of loss of the ability to communicate is objectified and is reasonably presumed to be permanent should be established in the progress notes presented for review. More specifically, is there a disturbance in the overall mental status or integrative functioning relative to brain activity? As noted in Section 4.1b, there are 10 separate assessments to be completed. The impairment rating provider assigning an award for a brain injury needs to address all 10 components. Additional concerns to include episodic neurologic disorders can also add to the COVID 19 brain injury impairment.

As for the heart, the impairment rating parameters as noted in Chapter 6 are considered. The distinction between a vascular issue, a valvular issue, or a muscular issue needs to be obtained. Testing, such as an echocardiogram, to establish the ejection fraction would be necessary to calculate the appropriate whole person impairment rating. If there is an extensive period of congestive heart failure resulting in cardiomyopathy, this finding would be an additional consideration with respect to the final whole person impairment rating. 

The pulmonary system, which would be the most prevalent compromised organ system, would be addressed utilizing Chapter 5. In this instance, comprehensive pulmonary function testing and noting the normal values, as well as the relative to FEV1, the FVC (forced vital capacity), and the oxygen diffusing capacity (DCO), are necessary criteria to establish which class of impairment is most applicable. 

Lastly, Chapter 11 would address if there was an acute kidney injury or another urinary tract compromise. Taking note of Section 11.1, identifying the specific functional losses and the findings noted on appropriate laboratory studies (creatinine clearance levels) are the most pertinent positive parameters for calculating the impairment. This would be another reason to track the laboratory studies with each subsequent progress note addressing this pathology. 

Please remember that each organ system will be assigned a whole person impairment rating and the final award would be calculated by combining these values via the “combined value chart”. As you can see, taking note of the compromised functions secondary to this infection, tracking the response to the treatment rendered, and noting the actual functionality of the various organ systems at the time of maximum medical improvement becomes paramount in the calculation of the impairment. Given the nature of these other organ systems, if there is any modest functional loss of two or more systems, one is easily looking at a greater than 15% whole person impairment rating.