AMA Guides® Newsletter - Issue Archive

Articles

1. Knee Osteoarthritis

   Christopher R. Brigham, Charles N. Brooks, James B. Talmage

   Pages 1–3, 7, 12

   DOI: 10.1001/amaguidesnewsletters.2005.MarApr01

   Abstract

   More than 20 million Americans have osteoarthritis (OA), which affects the knee more often than any other joint and is the most common cause of long-term disability in persons older than 65 years. Knee OA is common, particularly in older patients and especially the obese. Knee injury, depending on the severity and type, can increase the risk of developing and the rate of progression of OA. In assessing impairment for knee OA, the evaluator must obtain a thorough history and physical examination and identify all potential risk factors. To opine that an injury caused OA, the evaluator should demonstrate that the traumatized knee shows significant arthritis but that the contralateral uninjured knee is radiographically normal; for an evaluator to suggest that pre-existing arthritis was aggravated, the involved knee should show significantly more advanced OA than the contralateral joint. Joint space widths (cartilage intervals) of both knees must be measured carefully on anteroposterior films obtained standing with a film-to-camera distance of 90 cm (36 in) and the beam at the level of and parallel to the joint surface. Taking into account all of the data (history, physical findings, and radiographic measurements from both the involved and contralateral joint), the rating physician can assess causation, estimate impairment, and apportion the latter to one or more etiologies.
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2. Impairment Tutorial: Chapter 14 or 18 for Pain Complaints? Guidance From Chapter 14 and Other Mental Health Resources

   Robert J. Barth

   Pages 4–5, 8-9

   DOI: 10.1001/amaguidesnewsletters.2005.MarApr02

   Abstract

   This is the second in a series of articles that address pain complaints and mental illness. The AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, should not be used if the pain presentation is attributable to mental illness, and the evaluator must distinguish between presentations that should be evaluated using Chapter 18, Pain, and those that should be evaluated using Chapter 14, Mental and Behavioral Disorders. Chapter 14 is unique in its avoidance of numerical impairment ratings but has been praised for its internal consistency and emphasis on following the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). The only section of Chapter 14 that discusses pain complaints is somatoform pain disorders, which presents several problems, including nomenclature (the phrase somatoform pain disorder is antiquated and disappeared from DSM in 1994, and other forms of mental illness are not somatoform disorders). The DSM is the foundation of the evaluation process, and its discussion of any given mental illness is the gold standard definition of that illness; therefore, any attempt to evaluate pain complaints as a possible manifestation of mental illness must use DSM protocols. The article concludes with a discussion of the components of the evaluation process: awareness of the most prominent diagnostic possibilities; presenting complaints; health history; social history; review of records; family history; collateral interviews; and psychological testing.
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3. Quick Reference: Motion at the Wrist, Elbow, and Shoulder

   Pages 6–6

   DOI: 10.1001/amaguidesnewsletters.2005.MarApr03

   Abstract

   When they assess impairment, examiners must determine what “loss, loss of use, or derangement of any body part, organ system, or organ function,” occurred, according to the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth Edition. At the same time, the AMA Guides cautions examiners to avoid “double dipping,” or rating the same impairment twice: “Related but separate conditions are rated separately[,] and impairment ratings are combined unless criteria for the second impairment are included in the primary impairment.” For example, it is not appropriate for an examiner who is rating spinal impairment using a Diagnosis-related estimate (DRE) category to award an additional 3% whole person impairment (WPI) beyond the baseline rating for the category because of limitation in activities of daily living (ADLs), presumably at least in part because of residual pain, and then to award a further impairment rating for pain based on Chapter 18. Rather, the AMA Guides notes that “the impairment ratings in the body organ system chapters make allowance for any accompanying pain.” Duplicative and, therefore, erroneously inflated ratings sometimes are performed by physicians who are less experienced in using the AMA Guides or those who, due to patient advocacy or other reason, want to maximize ratings.
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4. Impairment Tutorial: No Double Dipping for Pain

   Christopher R. Brigham, Charles N. Brooks, James B. Talmage

   Pages 10–11

   DOI: 10.1001/amaguidesnewsletters.2005.MarApr04