AMA Guides® Newsletter - Issue Archive

Articles

1. The Challenge of Evaluating Asthma Impairment and Disability

   Mohammed I. Ranavaya

   Pages 1–4

   DOI: 10.1001/amaguidesnewsletters.1997.MayJun01

   Abstract

   The diagnostic criteria for asthma usually are straightforward and generally follow the Guidelines of the American Thoracic Society (ATS). The assessment of impairment and disability from asthma is complex because of the variable nature of the disease, and the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) gives physicians discretion to adjust the class of impairment based on the frequency of asthma attacks and the physician's judgment. A physician with expertise in lung disease may use the ATS Guidelines for impairment along with the AMA Guides to determine respiratory and whole person impairment, and a table compares the AMA Guides and the ATS Guidelines in support of assessing whole person impairment. An evaluation protocol addresses the steps in the process (all should be well documented): confirm the presence of asthma; determine its severity; estimate the permanent whole person impairment (a table lists classes of whole person impairment based on the AMA Guides and the ATS Guidelines); and assess work-related asthma. In some cases, an individual with airway hyperresponsiveness may not have an impairment but may have disability for specific jobs. The protocol and suggestions offered here may be practical in most circumstances for evaluating asthma impairment and disability.
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2. Impairment Tutorial: Impairment From Coronary Artery Disease

   James B. Talmage

   Pages 5–5

   DOI: 10.1001/amaguidesnewsletters.1997.MayJun02

   Abstract

   Coronary artery disease is quite common, and physicians often are asked about the work capacity of patients with coronary disease; less commonly are physicians asked to rate the patient's permanent impairment. In such cases, Chapter 6, Cardiovascular System, of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) is used to rate impairment. The AMA Guides directs the physician who is rating impairment to place the individual in one of four classes of impairment. Class 1 impairment is rarely used because patients often have neither significant lesions nor a history of angina. The likelihood of disease progression may qualify these individuals as impaired even in the absence of symptoms. Patients with Class 2 impairment have no symptoms even with moderately heavy activity, and moderate dietary adjustment or medication is required to prevent symptoms. Class 3 impairment describes individuals who have symptoms of congestive heart failure or angina with moderately heavy activity. According to the AMA Guides criteria, patients in Class 3 would qualify for US Social Security benefits. Class 4 impairment describes individuals who have symptoms during ordinary activity and should have signs or laboratory evidence of cardiac enlargement and abnormal ventricular function. For each class, the AMA Guides describes a range of impairment ratings and provides examples.
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3. Literature Review

   James B. Talmage

   Pages 6–6

   DOI: 10.1001/amaguidesnewsletters.1997.MayJun03

   Abstract

   Functional capacity testing typically involves musculoskeletal evaluations using instruments such as inclinometers, goniometers, range-of-motion machines, and strength analyzers. Depending on the organ system to be tested, a variety of tests are available to assess physiological competency (eg, liver function or renal function tests). The cardiopulmonary exercise test (CP Ex test) is one test that defines work capacity and addresses the two primary issues necessary for muscle movement: the adequacy of the cardiac output and that of the lungs to acquire oxygen and excrete carbon dioxide. A normal test requires correct functioning in five organ systems: the heart, the lungs, the hematopoietic system, the vascular system, and the muscles. The CP Ex test can discriminate between individuals with poor exercise capacity caused by hyperventilation, obesity, or malingering. The CP Ex test is not required when one is rating impairments according the AMA Guides to the Evaluation of Permanent Impairment, but the test may help physicians understand the basis for decreased exercise tolerance, thereby facilitating the impairment rating process. Finally, the CP Ex text is useful for assessing functional capacity but does not address all the physiologic, anatomic, and functional issues—no single test can do so—but the CP Ex test provides a very adequate way to address an individual's functional capacity.
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4. Impairment Questions and Answers

   Pages 6–6

   DOI: 10.1001/amaguidesnewsletters.1997.MayJun04

5. Clinical Update: Cardiopulmonary Exercise Testing

   Stephen L. Demeter

   Pages 7–7

   DOI: 10.1001/amaguidesnewsletters.1997.MayJun05