AMA Guides® Newsletter - Issue Archive

Articles

1. Apportionment of Musculoskeletal Injuries

   Stephen L. Demeter, Christopher Brigham, James B. Talmage, J. Mark Melhorn, Steven D. Feinberg

   Pages 3–11

   DOI: 10.1001/amaguidesnewsletters.2015.SepOct01

   Abstract

   When they apportion impairment in musculoskeletal cases, evaluators encounter a variety of unique issues and problems. The first step in apportionment is scientifically based causation analysis. Arbitrary or opinion-based unscientific apportionment estimates that amount to little more than speculation should be avoided. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth and Fifth Editions, are similar in their assessment of orthopedic impairment, but significant differences exist between these and the Sixth Edition. Individuals may experience impairments on several occasions. For example, if the first injury was rated using an earlier edition of the AMA Guides and a second injury occurs and is rated using a more current edition, then the most recent edition in the current jurisdiction is used to recalculate the rating for the first injury. Regarding which edition of the AMA Guides to use, evaluators should be aware of the jurisdictional requirements and also the timing to ensure that the individual is at maximum medical improvement. If the issue to be determined is apportioning the cause of the injury and not the impairment rating, then different criteria are used and the AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, is an invaluable resource. Extensive sidebars discuss qualitative vs qualitative apportionment and steps that evaluators can take to ensure that body regions and conditions are not confused (ie, that an apples-to-apples comparison is taking place).
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2. Cardiovascular Impairment Evaluation: Sixth Edition

   James B. Talmage, Jay Blaisdell

   Pages 12–14

   DOI: 10.1001/amaguidesnewsletters.2015.SepOct02

   Abstract

   To assess medical impairments, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) divides cardiovascular diseases into the following eight groups, each of which has its own grid: valvular heart disease; coronary artery disease; cardiomyopathies, pericardial heart disease, dysrhythmias, hypertensive cardiovascular disease, vascular diseases affecting the extremities, and diseases of the pulmonary artery. An accompanying table shows the criteria for rating permanent impairment due to valvular heart disease. Within the grids, the rows are divided into three main impairment variables: history, physical findings, and objective test results. The latter are essential in assigning cardiovascular impairment ratings. The AMA Guides names the objective test results variable as the key factor to underscore its role in assigning the impairment class in the cardiovascular chapter. For cardiovascular impairments, objective test results are always used to place the injury in its impairment class; therefore, objective test results are never used to modify the rating once the evaluator chooses the impairment class. Not all internal medicine chapters designate objective test results as the key factor, but all use one key factor that is clearly indicated in a footnote and one or two non-key factors. This rating scheme emphasizes objective test results, history, and physical findings and avoids incorporating variables twice.
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3. Shoulder Impairment Ratings: Sixth Edition

   James B. Talmage, Jay Blaisdell

   Pages 15–16

   DOI: 10.1001/amaguidesnewsletters.2015.SepOct03

   Abstract

   In many workers’ compensation systems, shoulder injuries are among the most common reasons for filing a claim, and greater familiarity with the significant differences in rating processes between the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth and Sixth Editions will help physicians avoid common pitfalls and improve the reliability of impairment ratings. One source of confusion associated with rating a shoulder is determining whether to use the range-of-motion (ROM) method or the diagnosis-based impairment (DBI) method. The AMA Guides, Sixth Edition, clearly states that DBI is the primary method of evaluation for the upper limb and that range of motion is used primarily as a physical examination adjustment factor and only when a grid permits its use as an option. An impairment rating that is calculated using ROM may not be combined with a DBI-based impairment rating; DBI is the primary method, and ROM should be used “only under specific circumstances.” When measuring ROM, evaluators should record all six measurements of shoulder motion for each arm and use the injured arm as a baseline. If two or more diagnoses are possible under the DBI method, evaluators should choose the highest causally related impairment rating from the shoulder grid and modify the clinical studies grade modifier.
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