AMA Guides® Newsletter - Issue Archive

Articles

1. Impairment and Disability: Using the Guides

   Christopher R. Brigham

   Pages 1–2

   DOI: 10.1001/amaguidesnewsletters.1996.SepOct01

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) is a widely used and accepted reference for the evaluation of permanent impairment. Many individuals and entities incorrectly consider the concepts of impairment and disability to be interchangeable, but the AMA Guides defines impairment as the “loss, loss of use, or derangement of any body part, system or function.” In contrast, disability is “an alteration of an individual's capacity to meet personal, social or occupational demands, or statutory or regulatory requirements, because of an impairment.” Thus, impairment evaluation is a medical determination, but evaluation or rating of disability is “a nonmedical assessment of the degree to which an individual does or does not have the capacity to meet personal, social, occupational, or other demands, or to meet statutory or regulatory requirements.” The AMA Guides help estimate the degree to which an individual's capacity to carry out daily activities has been diminished, but the AMA Guides for the most part is based on anatomic impairment, most commonly of the musculoskeletal system. The motivations of the patient, employer, and others often determine whether an impaired person also is disabled, and the AMA Guides clearly emphasizes that “impairment percentages derived according to Guides criteria should not be used to make direct financial awards or direct estimates of disabilities.”
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2. Impairment Tutorial: Rating Peripheral Nerve Disorders of the Upper Extremity

   Kathryn Mueller

   Pages 2–4

   DOI: 10.1001/amaguidesnewsletters.1996.SepOct02

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides) Fourth Edition, states that peripheral nerve impairments are determined by determining the percentage of the patient's motor and sensory loss. This article discusses the six steps necessary to rate a peripheral nerve impairment of the upper extremity: First, identify the nerve or nerves affected using relevant tables and figures. Second, locate the table that lists the nerve identified, and record the maximum loss attributed to that nerve for motor and sensory function. A table lists peripheral nerve charts in the AMA Guides, including nerves rated, table and page numbers, and type of rating (upper or lower extremity, foot, and so on). Third, grade the motor deficit of the nerve, and, using the appropriate table, find the percentage range and choose a number within the range that is appropriate for the patient; multiply the graded percentage by the total motor impairment found in step two. Fourth, determine the total deficit for the nerve by combining the motor and sensory deficits using the Combined Values Chart. Fifth, combine the total nerve deficit with other appropriate impairments. A table instructs raters how to convert to a whole person impairment. Sixth, grade the sensory deficit of the nerve. An example illustrates application of the six steps.
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3. Literature Review: Disability Evaluation

   James B. Talmage

   Pages 4–4

   DOI: 10.1001/amaguidesnewsletters.1996.SepOct03

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Third Edition, exclusively used the Range of Motion (ROM) Model to rate motion of the spine. The fourth edition requires the additional use of an inclinometer and also indicates that the Injury Model is the primary method for evaluating the spine; the ROM Model can be used as the differentiator or tie breaker. The ROM and the Injury Models cannot be used interchangeably, and the final rating always should be based on the Injury Model, not the ROM Model. One of the goals of changing the evaluation method is to create a more reproducible rating system. Because the Injury Model uses only objective findings present at the time of examination or found in the record, it is more reproducible. A further difference between the Injury and ROM Models is that in the former the examining physician rates the results of the injury, not the results of the treatment. The AMA Guides also requires that the patient's condition be stable—ie, not likely to change for one year. In the spine, the results of the injury, not the treatment, are rated, and often this can be done within several days of the injury.
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4. Clinical Update: The Spine

   Robert Haralson

   Pages 5–5

   DOI: 10.1001/amaguidesnewsletters.1996.SepOct04

   Abstract

   In the case of Brown v Campbell County Bd. of Educ., 914 S.W.2d407 (Tenn. 1995), the Tennessee Supreme Court found that use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, was proper and constitutional. Two claimants in this case challenged the constitutionality of Tennessee Statute 50-6-241, which stated, in part, that «the medical impairment rating [is] determined pursuant to the provisions of the American Medical Association Guides.» The Court upheld the constitutionality of the use of the AMA Guides and found that this use did not violate equal protection, in part because the legitimate state interests,—uniformity, fairness, and predictability—are equally applicable to the use of the AMA Guides: «If the Guides were not used, medical opinions would be more subjective, and perhaps arbitrary. It is no surprise, therefore, that most states either mandate, recommend, or frequently use the AMA Guides in Workers' compensation cases.» To date, every appellate court that has dealt with the AMA Guides has upheld its use and/or its constitutionality»; for additional information, see the following cases: Allen v Natrona County School District One, 811 p.2d 1 (Wy. 1991); Duran v Industrial Claim Appeals Office, 883 p.2d 477 (Colo. 1994); and Texas Workers’ Compensation Commission v Garcia, 893 S.W.2d 504 (Tex. 1995).
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5. Impairment Questions and Answers

   Pages 6–6

   DOI: 10.1001/amaguidesnewsletters.1996.SepOct05

6. Legal Update: Fourth Edition Use Upheld

   Steven Babitsky

   Pages 7–7

   DOI: 10.1001/amaguidesnewsletters.1996.SepOct06