AMA Guides® Newsletter - Issue Archive

Articles

1. Key Principles in Using the Guides (Part II)

   Henry J. Roth, Christopher R. Brigham

   Pages 1–2

   DOI: 10.1001/amaguidesnewsletters.1997.MarApr01

   Abstract

   This article (continued from the previous issue) discusses and clarifies 21 key principles for using the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fourth Edition. Tests of inconsistency are good but imperfect indicators of patients’ efforts, and if observations or test results are insufficient, the physician should explain the modified impairment assessment in writing. The AMA Guides includes rules for interpolating, measuring and rounding, and evaluating, and physicians should be familiar with them. In general, impairment percentages allow for pain that may accompany the impairing condition. If possible, the evaluator should remove a patient's protheses during evaluation. Physicians should consult the Combined Values Chart if the effects of treatment prevent adequate impairment management. A patient's decision to decline therapy for a permanent impairment should neither increase nor decrease the estimated impairment. The AMA strongly encourages use of the most recent of the AMA Guides. Impairment percentages derived according to AMA Guides criteria should not be used to make direct financial awards or direct estimates of disabilities. Combining, compared to adding, is a mathematical process to prevent estimating impairments greater than 100%, and the Combined Values Chart provides guidance for use. Divergent ratings should be matters of fact, not opinion.
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2. Impairment Tutorial: Rating Cranial Nerve and Spinal Cord Disorders

   Lorne Direnfeld

   Pages 3–4

   DOI: 10.1001/amaguidesnewsletters.1997.MarApr02

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, discusses rating cranial nerve and spinal cord impairments. Evaluation of impairment of the cranial nerves is based on clinical neurological assessment, and many cranial nerves also are addressed in other chapters of the AMA Guides (eg, the visual system or the ear, nose, and throat). With respect to cranial nerve I, an impairment estimate associated with anosmia or parosmia should be given only if this significantly interferes with daily activities. For cranial nerve II, the AMA Guides recommends ophthalmologic testing of visual fields and best correction. For cranial nerves III, IV, and VI, the reader is referred to section 8.3, and, for cranial nerve V, the AMA Guides provides a method of determining impairment associated with trigeminal neuralgia. A table provides data regarding impairment for conditions that affect the seventh cranial (facial) nerve; sensory loss related to the facial nerve does not interfere with activities of daily living. Auditory impairment (cranial nerve VIII) is rated according to criteria in the ear, nose, throat, and related structures chapter, including tinnitus. Cranial nerves IX, X, XI, and XII are involved in breathing, swallowing, speaking, and some visceral functions, and ratings criteria are presented. In terms of spinal cord impairments, the AMA Guides divides pathology into six categories: station and gait; use of the upper extremities; respiration; urinary bladder function; anorectal function; and sexual function.
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3. Impairment Questions and Answers

   Pages 4–5

   DOI: 10.1001/amaguidesnewsletters.1997.MarApr03

   Abstract

   Controversy attends use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in defining injured workers’ permanent partial disability benefits: States desire an efficient, nonsubjective way to determine benefits for nonscheduled injuries and are using the AMA Guides to define the extent of disability. Organized labor is concerned that use of the AMA Guides, particularly with modifications, does not yield a fair analysis of an injured worker's disability. From its first issue, The Guides Newsletter emphatically emphasized and clearly stated that impairment percentages derived according to AMA Guides criteria should not be used to make direct financial awards or direct estimates of disability. The insurance industry and organized labor differ about the use of the AMA Guides in defining permanent partial disability (PPD). Insurers support use of the AMA Guides because they seek a uniform system that minimizes subjectivity in determining benefits. Organized labor is particularly concerned about the lack of fairness of directly equating impairment and disability, and if the rating plays a role in defining disability, additional issues also must be considered. More states are likely to use the AMA Guides with incorporation of additional features such as an index to PPD.
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4. Legal Update: Using the Guides for Permanent Partial Disability Determinations

   Christopher R. Brigham

   Pages 6–6

   DOI: 10.1001/amaguidesnewsletters.1997.MarApr04

   Abstract

   Rating the impairment related to various chronic painful conditions, including headaches, is challenging and is addressed in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in a section of the chapter on pain. Primary headache disorders include migraines, tension-type headaches, and cluster headaches caused by disturbances in the central nervous system. Headaches occur with varying intensities and frequencies but follow three broad patterns: 1) minimal, slight, moderate, and marked headache; 2) cycles or episodes that may last from moments to years; and 3) consistent and persistent pain that may last years, decades, or a lifetime. Physicians should estimate impairment related to headache pain according to the procedures discussed in section 15.8, including a multidimensional assessment of an individual's capabilities, including biological, psychological, and social aspects and excluding the existence of a separate comorbid pathologic process. The AMA Guides does not provide specific numeric values for impairment of headache or for pain itself. For patients who have a primary headache disorder, the physician should clearly understand the frequency and severity of the condition, the approach to treatment, and the effects of headaches on activities of daily living. The discussion of headaches in the AMA Guides emphasizes the importance of careful evaluation over merely assigning a numeric value to an impairment.
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5. Clinical Update: Impairment Evaluation of Headaches

   Lorne Direnfeld

   Pages 7–7

   DOI: 10.1001/amaguidesnewsletters.1997.MarApr05