AMA Guides® Newsletter - Issue Archive

Articles

1. Sex-Specific Conditions, Gender, and Evaluation Using the AMA Guides

   Linda Cocchiarella, Kathryn Mueller

   Pages 3–8

   DOI: 10.1001/amaguidesnewsletters.2016.JulAug01

   Abstract

   Concerns about potential sex and gender bias during impairment and disability evaluations have been raised; this article reviews ways in which sex and gender contribute to the unique presentation, manifestations, treatment, and functional outcome of medical conditions and how these differences can be appropriately addressed using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. Sex differences are objective and are based on biochemical and biological factors; gender refers to cultural attitudes that are learned and vary by culture, history, and ethnicity. The AMA Guides acknowledges individual variations and advocates a flexible approach: Physicians can choose among sections of the AMA Guides those best suited to account for individual and sex differences. The AMA Guides does not advocate different evaluation of medical conditions based on sex, except for sex-specific disorders (eg, unique male or female reproductive organs). The health care system is striving to eliminate gender and sex bias, and impairment and disability are following by attempting to eliminate bias by offering individualized assessments of how impairment affects the injured organ, use of unique rating methods to fully characterize the impairment, use of rating ranges to account for individual variability and sex, and by ascribing equal values to gender-ascribed activities of daily living.
   Show more

2. CASE STUDY: Gender-Specific Impairment Rating Examples

   Pages 6–7

   DOI: 10.1001/amaguidesnewsletters.2016.JulAug02

   Abstract

   Accurate pulmonary impairment ratings depend on a valid and reliable lung function test and appropriate application of the criteria provided in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. The two lung function tests are dynamic and static; the principal dynamic test is the cardiopulmonary stress test [see sidebar, “Cardiopulmonary Exercise Testing,” in this issue of The Guides Newsletter]. To rate pulmonary impairment using Chapter 5 of the AMA Guides, Sixth Edition, a physician should obtain the spirometric results and the value for the diffusion of carbon monoxide across the alveolar capillary membrane of the lung (DLCO); the latter should be administered according to American Thoracic Society criteria. A six-minute walk test is a standard test of pulmonary reserve in lung disease patients and may be part of the individual's physical examination. Each diagnosis table in Chapter 5 is divided into variables or factors that determine the impairment rating. Each impairment class (except 0) has five grades (A through E). Once the evaluator uses objective test results to assign the impairment class, the non-key factors are considered to determine whether the impairment should be adjusted from the default value. To determine the adjustment, the evaluator subtracts the impairment class integer from each non-key factor integer, and the differences are summated for the net adjustment.
   Show more

3. Pulmonary Impairment Rating

   Jay Blaisdell, James B. Talmage, Stephen Demeter

   Pages 8–11

   DOI: 10.1001/amaguidesnewsletters.2016.JulAug03

   Abstract

   Nonspecific spinal pain and intervertebral disc herniations are common, and in evaluating spinal impairment physicians should carefully assess the significance of imaging findings, physical examination findings, and reports of limb pain. A case example illustrates key principles in assessing cervical pain in an individual with questionable arm complaints. A 62-year-old man had a slip and fall injury. Imaging studies revealed degenerative disc disease with disc bulges and without specific disc herniations according to the radiologists, but his physician reviewed magnetic resonance imaging (MRI) films and reported multiple disc herniations. The case example illustrates the significance of the finding of degenerative disc disease, determining whether to rate for “soft tissue and nonspecific conditions” or “motion segment lesions,” and assessing “nonverifiable radicular complaints.” The authors note that cervical degenerative disc “disease” is more aptly a radiologic diagnosis reflecting aging rather than a clinical syndrome and does not necessarily imply that the degenerative disc disease is the cause of the pain. To distinguish between nonverifiable radicular complaints without objective evidence of radiculopathy and unreliable vague complaints involving the extremity, evaluators should determine that the complaints are consistently and repetitively recognized in medical records and that they lie in the distribution of a single nerve root that the examiner can name. The diagnosis of “intervertebral disc herniation” cannot be made, and instead the “nonspecific chronic pain” diagnosis can be used. Nor can the diagnosis of alteration of motion segment integrity be used because the case lacks radiographically documented instability.
   Show more

4. Cervical Pain and Questionable Arm Complaints: Sixth Edition Rating

   Christopher R. Brigham, James B. Talmage, Gunnar Andersson

   Pages 12–14

   DOI: 10.1001/amaguidesnewsletters.2016.JulAug04

5. Book Review: AMA Guides® to Navigating Disability Benefit Systems: Essentials for the Health Care Professional

   Les Kertay, Marjorie Eskay-Auerbach, Mark H. Hyman, David Torrey, WC Judge

   Pages 15–16

   DOI: 10.1001/amaguidesnewsletters.2016.JulAug05