Trauma vs. Degeneration

One issue we often face in representing trauma victims is the defense argument that our client’s condition was “preexisting” or the result of “degeneration,” and not due to trauma caused by someone else. The definition of degeneration is “deterioration of a tissue or an organ in which its vitality is diminished or its structure impaired.” That defition says nothing about trauma versus the normal aging process.

However, the defense often argues that degeneration is a natural result of the aging process and can be accompanied with or without pain. In reality, degeneration follows both normal aging and traumatic injury. The difference is that degeneration occurs at an acclerated rate following a traumatic injury — at up to 6 times the normal rate. 

Because degeneration does occur at a lesser rate naturally, it is often a target of the defense. The argument often goes like this: “Mr. X wasn’t injured in this incident — if he’s not faking, then the only reason he hurts is because he’s getting old, just like my grandmother.” That is, the defense often argues that degeneration is the cause of clinical findings, rather than trauma.

This degeneration in lieu of trauma argument is a logical fallacy, especially where the victim was asymptomatic before the traumatic event. The defense would like you to believe that the victim was fragile — so fragile, in fact, that they were bound to start experiencing symptoms due to degeneration at any moment. But, the argument goes, the traumatic experience couldn’t have been the cause — the fact that symptoms started was mere coincidence. This “reverse kryptonite” argument has been exposed as a fatally flawed statistical argument. In fact, the likelihood that injury symptoms from a low impact collision are caused by degeneration, rather than a concurrent traumatic event, are 7300 to 1. Statistically, that is less than .01%.

Furthermore, from a statistical standpoint, preexisting degenerative changes make a person much more likely to be injured due to trauma. This is common sense: if a body part is already weakened, then trauma to that body part is more likely to cause injury. This is why injury victims with preexisting degeneration often suffer worse injuries than would ordinarily be expected.

5843433-10703722-thumbnail.jpg

Fortunately for injury victims everywhere, medical technology has found a way to differentiate between, on one hand, relatively normal aging and, on the other hand, injuries resulting from trauma. As one example, the peer-reviewed journal Neuroradiology published several articles in the early 2000’s in which researchers gave the patients 2–9 years to heal following a traumatic event, took MRIs of the patients, and compared them with MRIs taken of an uninjured control group. The researchers looked to whether the MRI showed a ligament tear; as shown in the figure at right, this ligament (shown by the dark black  line) has been disrupted through more than 2/3 of its width, which is  classified as a Grade 3 tear. The researchers concluded alar ligaments and the tectorial and posterior atlanto-occipital membranes (3 types of neck ligaments) are only significantly injured (from 1/3 torn to fully torn) in traumatic events. That is, the researchers were unable to find signficantly torn neck ligaments in an uninjured control group. The conclusion: seriously torn neck ligaments only result from trauma, not from normal aging processes such as degeneration.