North York Rehabilitation Centre
In the Insurer’s Examination Catastrophic Determination, Catastrophic Impairment Rating, dated April 24, 2015, Dr. J. Castiglione, of North York Rehabilitation Centre, provided whole person impairment scores under criterion 7 (physical impairment) for Ms. Czombos’ injuries and impairments sustained as a result of the accident. They are summarized as follows:
1. Neck Pain
Dr. Soriano, Orthopaedic Surgeon, examined Ms. Czombos’ neck injury and concluded that overall he “does not think this lady has any musculoskeletal issues that are directly attributable to the accident of 2009.” From a musculoskeletal perspective, her cervical spine injury falls under Diagnostic Related Estimates (DRE) Category I cervicothoracic impairment, which equates to a 0% whole person impairment. (Chapter 3, Page 103 of the Guides).
2. Back Pain
Dr. Soriano, Orthopaedic Surgeon, examined Ms. Czombos’ back injury and concluded that overall he “does not think this lady has musculoskeletal issues that are directly attributable to the accident of 2009”. From the musculoskeletal perspective, her lumbar spine injury falls under DRE Category I, which equates to a 0% whole person impairment. (Chapter 3, Page 102 of the Guides).
3. Bilateral Shoulder Pain
Dr. Soriano, Orthopaedic Surgeon, examined Ms. Czombos’ neck injury and concluded that overall he “does not think this lady has any musculoskeletal issue that are directly attributable to the accident of 2009”. Shoulder ranges of motion were entirely normal and Dr. Soriano did not specifically apply a shoulder diagnosis in his report, which would extrapolate to a 0% whole person impairment for the shoulders. Chapter 3, Section 3.1j of the Guides (pages 41- 45) addresses impairment ratings related to loss of shoulder motion; however, as there is no loss of motion as per Dr. Soriano’s examination there are no findings on which a rating would apply.
In his report, dated April 24, 2015, Dr. Soriano stated:
Overall I do not think this lady has any musculoskeletal issues that are directly attributable to the accident of 2009. Her medical history is very complicated and convoluted with significant psychological overtones together with overlapping injuries over the past 20 years or so, some work related and some related to the three motor vehicle accidents she was involved in.
The opinions expressed here are those of the evaluator. The evaluation has been conducted on the basis of a medical examination and documentation provided with the assumption that this information is true and correct. If more information becomes available, an additional report or service may be required. Such information may or may not alter the opinion of this evaluation.
From a musculoskeletal perspective, her cervical and lumbar spine injuries both fall under Diagnostic Related Estimates (DRE) Category I.
There is 0% impairment of the whole person. I suggest a psychologist determine the nature of her psychological impairment. However, the post-traumatic stress disorder diagnosis preceded the accident of 2009.
In the Insurer’s Examination Catastrophic Determination Multidisciplinary Addendum, dated December 5, 2016, Dr. Soriano stated that, “she has no specific musculoskeletal issues that are solely attributable to the accident of June 29, 2009.”
I prefer the opinion of Dr. Ranney over that of Dr. Soriano. I accept Dr. Ranney’s opinion and give it significant weight. I give less weight to Dr. Soriano’s opinion. My reasons for these conclusions follow.
I find the evidence of Dr. Ranney persuasive. His report was thorough and contains detailed supporting reasons for his opinions. He analyzed Ms. Czombos’ history of motor vehicle accidents, reviewing 69 documents, including radiographic reports/studies (including Dr. Baird’s digital motion x-ray study of Ms. Czombos), he reviewed the treatment received by Ms. Czombos since the motor vehicle accident of June 29, 2009, significant radiographic assessments, Ms. Czombos’ personal history, education, employment, history of past health and functional inquiry, current medications, current symptoms, and disability, reviewed pain diagram and neck and back pain questionnaires completed by Ms. Czombos, examined Ms. Czombos, provided orthopaedic diagnoses that are causally related to the motor vehicle accident of June 29, 2009, and orthopaedic diagnoses unrelated to this accident, answered specific questions, and considered the opinions contained in the Insurer’s Examination of Catastrophic Determination by Rajwani, Castiglione, Soriano, Kiraly, Shaw, and Mark of North York Rehabilitation Centre, that states on page 13 “Ms. Czombos is not considered catastrophic and rates her neck pain and back pain 0% WPI”, which Dr. Ranney strongly rejects regarding her spine because they did not have access to radiographic assessment loaded by gravity and with movement.
I find Dr. Ranney’s evidence to be compelling. The facts on which his opinions are based are clearly delineated, are accurate and are complete. The preponderance of the medical and non-medical evidence supports his opinions. Overall, his testimony withstood a forceful and thorough cross-examination conducted by counsel for Wawanesa.
By contrast, I find Dr. Soriano’s opinion less persuasive and therefore give it less weight than the opinion of Dr. Ranney. Dr. Soriano’s reasoning with respect with to causation and Ms. Czombos’ level of impairment of the whole person is not compelling. There is a lack of detailed supporting reasons and analysis to provide a solid foundation for his opinion. His opinion is not supported by the weight of the medical and non-medical evidence. His diagnosis is based on inadequate evidence and assessments. Ms. Czombos’ impairments are simplistically described and the analysis is not carried sufficiently further. During his examination of Ms. Czombos, Dr. Soriano did not attempt downward pressure on her neck (Spurlings test) which, according to Dr. Ranney, he should have. Dr. Soriano did not have access to the voluminous documents, including a radiographic assessment loaded by gravity and with movement, namely, Dr. Baird’s June 9, 2015 Digital Motion X-ray study of Ms. Czombos, which were reviewed by Dr. Ranney. Dr. Soriano focuses on whether Ms. Czombos has any musculoskeletal issues that are directly or solely attributable to the accident of June 29, 2009, instead of conducting the requisite analysis in respect of apportionment or aggravation of a pre-existing medical condition or infirmity as required under the Guides.
Dr. Soriano’s reports are unhelpful and warrant little weight.