Core Forensic Approach
A chain of medical reasoning — not a records summary.
When spine and musculoskeletal cases need more than a chart review, courts turn to credentialed medical expertise. Twenty-five years of forensic evaluation — with particular depth in spine — applied through a consistent structure of analysis, whether the case involves the cervical, thoracic, or lumbar spine, or the extremities and other musculoskeletal structures.
An objective evaluation, grounded in findings — not advocacy.
The Causation Standard
Three legs a med-legal causation opinion must stand on.
Before the five pillars of analysis can support a defensible opinion, the underlying causation framework must satisfy three independent requirements. A causation opinion that cannot clear all three is vulnerable — regardless of how thorough the clinical findings are.
I
Biological Plausibility
The mechanism of injury is capable, physiologically, of producing the claimed pathology — for example, a rear-end MVA with sufficient delta-V can plausibly cause a disc annular tear. If the mechanism cannot produce the injury, the opinion fails at the threshold.
II
Temporal Relationship
Symptom onset and diagnostic findings fit a defensible timeline relative to the injury event, without unexplained gaps. A finding that appears months after the event with no intervening documentation requires explanation — silence is not a bridge.
III
Exclusion of Alternative Causation
Other plausible causes — degenerative disease, prior injury, unrelated pathology — have been considered and reasonably ruled out or apportioned. An opinion that ignores competing explanations is not objective; it is advocacy.
Six Pillars of Analysis
Mechanism of Injury
Establishing the precise biomechanical event — the forces applied, the direction of loading, the velocity and delta-V where applicable — and determining whether that mechanism is physically capable of producing the claimed pathology at the claimed spinal or musculoskeletal level. Without a credible mechanism, the entire causation chain is unsupported.
Degenerative Baseline
Establishing where the affected structure — spinal or extraspinal — stood in the degenerative process before the injury, so pre-existing findings are properly separated from trauma-related pathology rather than left to blur the picture.
Pain Source Mapping
Identifying every contributing pain generator, not just the most obvious diagnosis — because an incomplete map of pain sources, spinal or elsewhere in the musculoskeletal system, produces an incomplete opinion.
Instability-to-Permanency Chain
Tracing dynamic instability to specific ligamentous or structural pathology, and from there to a permanency opinion that is defensible because it's built on objective findings, not inference. Permanency opinions are supported by AMA Guides impairment ratings — 5th and 6th Edition — applied across a wide range of musculoskeletal conditions.
Injury Dating
Establishing the temporal relationship between trauma and findings — testing whether the timeline actually supports the underlying causation story.
Functional Loss Assessment
Quantifying disability and persistent functional impairment attributable to the injury.
Where the Pillars Converge
Triangulating to causation and apportionment.
Causation
Triangulated from the degenerative baseline, pain source mapping, and injury dating together: does the pre-injury condition of the structure, the identified pain generators, and the temporal relationship between trauma and findings all point to the same conclusion about what caused the current presentation? A causation opinion that doesn't reconcile all three is incomplete.
Apportionment
Drawing on that same triangulation and carrying it forward into permanency and functional loss findings: once causation is established, what portion of the current functional loss is attributable to the acute injury versus that which pre-dated the crash (applying the core thin skull or eggshell plaintiff rule) — separated out, with objective support, level by level.
At the Core of Every Evaluation
Where was this patient in the degenerative process at the time of the injury?What is the objective evidence of acute pathology — including, in spine cases, correlating instability at the involved motion segments — versus what is chronic?What level of permanent impairment or persistent functional loss, quantified under the AMA Guides, is actually attributable to the injury?And how does that impairment apportion between injury and pre-existing condition?
Diagnostic Methodology
Biomechanical and Imaging Analysis
Dr. Dickman's expert opinions are supported by comprehensive imaging analysis utilizing FDA-cleared diagnostic protocols for objective measurement and pathology assessment.
Spinal Biomechanics
Motion segment stability is evaluated using FDA-cleared software analysis of flexion-extension radiographs. Objective measurements of segmental translation, rotation, and ligamentous integrity are correlated with peer-reviewed biomechanical thresholds (AOMSI standards, Panjabi principles) to assess causation and injury mechanisms.
Advanced Imaging Interpretation
MRI and CT studies are reviewed independently and supplemented with FDA-cleared software tools for standardized pathology detection, measurement, and chronicity assessment of acute vs. chronic degenerative changes.
Reproducible Methodology
All objective findings — measurements, software outputs, and biomechanical correlations — are documented, reproducible, and available for independent verification. Dr. Dickman's opinions integrate radiologist baseline interpretations with independent clinical review and objective data analysis.
Peer-Reviewed Foundation
All biomechanical and causation opinions are anchored to peer-reviewed literature on spinal pathophysiology, injury mechanisms, and ligamentous thresholds. Complete citations and methodology are provided in every report.
D.C., F.P.S.C. — Fellowship in Primary Spine Care, Jacobs School of Medicine
25 years of forensic spine and musculoskeletal evaluation; thousands of QME and SIBTF reports authored
Nationwide expert witness recognition in civil court
Academic Credentialing
