AMA Guides® Newsletter - Issue Archive

Articles

1. Rating Cognitive Impairment, Part I: Case Example Illustrates Need for Adherence to AMA Guides, Sixth Edition Methodology

   Robert J. Barth

   Pages 3–10

   DOI: 10.1001/amaguidesnewsletters.2017.JanFeb01

   Abstract

   The assessment of impairment due to alteration in mental status, cognition, and highest integrative function may be challenging. A review of impairment assessments performed by others can provide valuable insights, including an appreciation of how evaluators may misapply the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. As a teaching example, this article presents an erroneous rating for a claim of cognitive impairment. The authors point out that most of the misdirection in the case example could be identified with reference to the AMA Guides, Sixth Edition, which reveals discrepancies between the rating processes in this case and actual sixth edition methodology. Nevertheless, the case example involved certain components that were so unconventional that it would have been impossible for the sixth edition contributors to anticipate the need to write a text that would have prevented these errors. The process of sorting out this misdirected rating revealed a previously unanticipated need to clarify sixth edition methodology, and the present article provides such clarification. The concluding section of this article provides a step-by-step protocol for the AMA Guides, Sixth Edition, methodology that involves rating cognitive impairment using Section 13.3d, Mental Status, Cognition, and Highest Integrative Function. The fourteen steps outline a meticulous process based on appropriate clinical assessment, application of evidence-based medicine, and the process outlined in the AMA Guides, Sixth Edition.
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2. Shoulder Pain at Work: Causation Analysis

   Joel Weddington, Charles N. Brooks, Mark Melhorn, Christopher R. Brigham

   Pages 11–16

   DOI: 10.1001/amaguidesnewsletters.2017.JanFeb02

   Abstract

   In most cases of shoulder injury at work, causation analysis is not clear-cut and requires detailed, thoughtful, and time-consuming causation analysis; traditionally, physicians have approached this in a cursory manner, often presenting their findings as an opinion. An established method of causation analysis using six steps is outlined in the American College of Occupational and Environmental Medicine Guidelines and in the AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, as follows: 1) collect evidence of disease; 2) collect epidemiological data; 3) collect evidence of exposure; 4) collect other relevant factors; 5) evaluate the validity of the evidence; and 6) write a report with evaluation and conclusions. Evaluators also should recognize that thresholds for causation vary by state and are based on specific statutes or case law. Three cases illustrate evidence-based causation analysis using the six steps and illustrate how examiners can form well-founded opinions about whether a given condition is work related, nonoccupational, or some combination of these. An evaluator's causal conclusions should be rational, should be consistent with the facts of the individual case and medical literature, and should cite pertinent references. The opinion should be stated “to a reasonable degree of medical probability,” on a “more-probable-than-not” basis, or using a suitable phrase that meets the legal threshold in the applicable jurisdiction.
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