TN 2 (06-15)

DI 28010.025 Examples of Cases With and Without Medical Improvement (MI)

A. Example – lumbar laminectomy with no MI

1. Comparison point decision (CPD) findings

An individual with a herniated nucleus pulposus underwent a laminectomy at the time of the CPD. A postoperative myelogram showed evidence of a persistent defect in the lumbar spine. He had pain in his back, as well as pain and a burning sensation in his right foot and leg. Evidence did not show muscle weakness or neurological changes, but it did show a moderate decrease in motion of the back and leg.

2. Continuing disability review (CDR) findings

The treating physician has seen the individual every two or three months for the past 2 years. No further myelograms have been done. The individual continues to complain of pain in the back and right leg especially when sitting or standing for more than a short period. The doctor reports a moderately decreased range of motion in the back and right leg and still reports no muscle atrophy or neurological changes.

3. Decision on MI

The evidence does not show changes in symptoms, signs, or laboratory findings on which to base a finding of decreased medical severity. Find no MI.

B. Example – rheumatoid arthritis with MI

1. CPD findings

Benefits were awarded based on laboratory results showing rheumatoid arthritis. The treating physician reported persistent swelling and tenderness of the individual's fingers and wrists and that the individual complained of joint pain.

2. CDR findings

Tests still show rheumatoid arthritis, but due to therapy the individual's fingers and wrists have not been significantly swollen or painful for the past year.

3. Decision on MI

Changes in symptoms and signs show decreased medical severity. Under DI 28010.115 (Impairment Subject to Temporary Remission), the improvement has been sustained long enough to establish remission. Find MI.