AMA Guides® Newsletter - Issue Archive

Articles

1. Permanent Impairment—Disability Rating Study: Impact of the AMA Guides on Permanent Disability Ratings in the State of California

   Christopher R Brigham, Dave Bellusci, Terry Beuret

   Pages 1–5, 8-11

   DOI: 10.1001/amaguidesnewsletters.2005.JulAug01

   Abstract

   Following passage of California Senate Bill No. 899 (SB 899) in 2005, disability in California is rated using the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth Edition. The authors compare the disability ratings under the new law to those under the pre-2005 California Permanent Disability Rating Schedule. The authors reviewed 267 cases, of which 250 were ratable, and the ratings of expert reviewers who used the AMA Guides were compared with the ratings of the pre-2005 evaluations (the reviewers who used the AMA Guides to examine the earlier evaluations were blinded to the results of the earlier evaluations). The average permanent disability ratings were 22% under the old schedule and 6.4% under the new schedule, possibly because the current AMA Guides bases impairment primarily on objective data, not subjective complaints and opinions regarding work restrictions. The AMA Guides also has changed certain tests and minimized others (eg, range of motion and grip, respectively). Study limitations include sample selection and differences between pre-2005 evaluators and the highly proficient experts who used the AMA Guides for the present study. The authors conclude that this study shows ratings that are lower than those typically given by treating physicians and other examiners, and they note potential causes of the discrepancies, including evaluation by physicians who are not yet expert and experienced in using the AMA Guides.
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2. Impairment Tutorial: Chapter 14 or 18 for Pain Complaints? Summation, Case Example, and Broader Implications

   Robert J. Barth

   Pages 4–7

   DOI: 10.1001/amaguidesnewsletters.2005.JulAug02

   Abstract

   In the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth Edition, two chapters claim relevance for pain complaints that lack an objectively demonstrable general medical basis: Chapter 14, Mental and Behavioral Disorders, and Chapter 18, Pain. Parts 1 and 2 of this four-part series examined forms of mental illness that commonly invoke complaints of pain; Part 2 also evaluations using the mental/behavioral chapter vs the pain chapter, and Part 3 noted the self-negating nature of the pain chapter's rationale (ie, the pain chapter presents a rationale that, taken literally, indicates it should not be used). A detailed case example illustrates how the decision about using the mental/behavioral chapter or the pain chapter often can be clarified by simply performing a thorough clinical evaluation (see Part 2 of this series). Examiners should be aware of the role of thoughts, behavior, and environmental contingencies on presentations of chronic pain even when no scientifically credible and objective general medical findings explain the pain. For example, the AMA Guides points out that in as much as 85% of low back pain cases, no explanatory physical pathology can be identified; therefore, readers are encouraged to be mindful of the professional literature. The authors of this series deny any attempt to move all instances of chronic pain into the category of mental illness but report little reason not to do so.
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