AMA Guides® Newsletter - Issue Archive

Articles

1. International Use of the AMA Guides to the Evaluation of Permanent Impairment

   Mohammed Ranavaya, Christopher R. Brigham

   Pages 1–5

   DOI: 10.1001/amaguidesnewsletters.2011.MayJun01

   Abstract

   In the United States, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) is used in state and federal workers’ compensation systems and in automobile casualty and personal injury arenas. The AMA Guides is used in similar ways internationally. Most workers’ compensation jurisdictions in Canada use the AMA Guides formally by statute or regulation or accept its use informally as a standard tool to rate impairment. In Australia, the AMA Guides is used in both federal (Australian Commonwealth) and individual states’ (or territories’) compensation schemes; two tables show how almost all states in Australia have legislated various editions of the AMA Guides for use in workers’ compensation and motor traffic accident compensation schemes. New Zealand's Accident Compensation Commission (ACC) previously used the AMA Guides, Fourth Edition; beginning in July 2011 ACC uses the sixth edition. Hong Kong uses the AMA Guides as a reference in evaluating workers’ compensation and motor vehicle claims; Malaysia uses the AMA Guides officially in adjudication; and impairment rating in Asian countries such as Taiwan, Korea, and Singapore are influenced by the philosophy and principles of the AMA Guides. South Africa uses the AMA Guides, Sixth Edition, to determine serious injury, and other editions are used in South Africa's workers’ compensation schemes. Many countries in Europe and the Middle East use the AMA Guides as a reference for determining impairment and in workers’ compensation and social welfare schemes.
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2. Heart Transplant Impairment Evaluation

   Stephen L. Demeter

   Pages 5–8

   DOI: 10.1001/amaguidesnewsletters.2011.MayJun02

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not specifically address how to rate heart transplants, but by applying principles used in rating similar illnesses, the evaluator can assess permanent impairment. The fourth and fifth editions of the AMA Guides contained directions for rating impairment created by a heart transplantation. Since these editions appeared, more heart, kidney, lungs, hands, and even faces have been transplanted. The AMA Guides, Sixth Edition, provides guidance only on rating individuals who received a kidney transplant, but this article describes a method for rating individuals following cardiac transplant and using principles in the cardiovascular chapter in the sixth edition of the AMA Guides. The steps are as follows: 1) rate using Table 4-7 Criteria for Rating Impairment due to Cardiomyopathies; 2) use classes 2, 3, or 4 for rating the posttransplant individual; 3) an individual who is posttransplant with totally normal cardiac physiological function is rated as class 2, level A; 4) combine with the burden of treatment compliance impairment caused by antirejection medications; and 5) combine with impairment found in any other organ system resulting from medications used to treat the heart, infections, and rejection. This article shows that if a specific, medically documented injury or illness is not addressed in the AMA Guides, the evaluator can apply the rating principles used in rating similar conditions in order to determine impairment.
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3. Can Acromioplasty Result in Impairment?

   J. Mark Melhorn, Charles N. Brooks, James B. Talmage

   Pages 8–11

   DOI: 10.1001/amaguidesnewsletters.2011.MayJun03

   Abstract

   To determine if an acromioplasty is impairing, an evaluator must know shoulder anatomy, the diagnosis or diagnoses, what treatment was provided, and the patient's present status. Over time, the earlier classification of shoulder impingement has been modified, and the current classification was adopted in 1994. At present, acromioplasty often is not the primary surgery but rather is one component of subacromial decompression with or without concomitant rotator cuff and/or intra-articular shoulder surgery. Until the sixth edition, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) did not address the question whether acromioplasty itself constitutes an impairment. In the fourth and fifth editions of the AMA Guides, although open or arthroscopic acromioplasty commonly results in temporary shoulder pain, stiffness, and weakness, the surgical procedure itself, barring complication, results in no permanent impairment. According to the AMA Guides, Sixth Edition, if an acromioplasty eliminated impingement and resulted in no pain or significant objective findings at maximal medical impairment, no impairment occurred. Diagnosis-based impairment is considered the rating method of choice, but range of motion is used primarily in the physical examination adjustment grid. Further, surgical error and/or complications may result in ratable motion and/or strength deficits. The AMA Guides, Fourth and Fifth Editions, also provide a means to rate impairment due to any concomitant distal clavicular resection.
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