AMA Guides® Newsletter - Issue Archive

Articles

1. Is a Condition a Ratable Impairment? Nuances in Assessing Preexisting Conditions

   Christopher R. Brigham, Charles N. Brooks, Stephen Demeter, Lorne Direnfeld, Randy Soo Hoo

   Pages 3–5

   DOI: 10.1001/amaguidesnewsletters.2017.MayJun01

   Abstract

   In order to answer questions posed by their clients, evaluating physicians must understand the context of a case or jurisdiction, in part because medical and legal perspectives may differ when an evaluator assesses issues such as causation and apportionment. A condition is not necessarily a ratable impairment, nor do symptomatic conditions necessarily prevent an individual from working. Attorneys may pose very specific apportionment questions based on laws unique to a given jurisdiction; for example, a patient may have an occupational injury or illness that results in impairment, but causation of the impairment may be multifactorial and may involve, for example, age-related degeneration, a pre-existing injury or illness, an occupational injury or illness, and/or subsequent trauma or disease. In some states, the presence of a pre-existing condition when an employee is injured may involve Second Injury Funds that were created to relieve a portion of the employer's/insurer's claim costs when the employer hired or retained an employee with a pre-existing medical condition who then suffered a “second” injury. The latter situation requires more extensive treatment and/or a greater disability due to the combined effects of both conditions. Apportionment of causation and impairment may be complex, requiring evaluation of nonoccupational and occupational risk factors and the natural history of the underlying condition.
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2. Imprecision in the Evaluation of Workers’ Compensation Psychological Injury Claims

   Pamela A. Warren

   Pages 6–13, 16

   DOI: 10.1001/amaguidesnewsletters.2017.MayJun02

   Abstract

   Psychological conditions with severe symptoms can result in considerable impairment in functioning, and psychological disability claims, also called behavioral health disability, have increased during the past two decades. A review of states’ workers’ compensation (WC) systems shows no overlap between systems; that is, all states and federal WC systems have unique terminology, rules, and laws. In order to thoroughly evaluate the individual, evaluators must use a biopsychosocial approach that combines aspects of biological, psychological, and psychosocial issues. Studies consistently demonstrate a high degree of comorbidity between physical and psychological conditions, but frequently only the former are identified and treated. Current disability systems use byzantine definitions of disability and require professional opinions and documentation that do not comport with current psychological standards of care, introducing imprecision. Many issues relating to WC terminology and laws can be addressed if the Daubert standard is incorporated into any amendment of WC state and federal laws. The Daubert standard requires that currently accepted scientific methods be used when a professional offers testimony as an expert or is submitting professional treatment records (eg, in a WC determination). Compliance with the Daubert standard requires more consistent, objective professional documentation and testimony to ensure even-handed decisions that align with standards of psychological care. One observer has suggested that the Daubert standard is a mechanism by which junk science is kept out of legal proceedings.
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3. Do Imaging Findings Predict the Need for Work Restrictions?

   Marjorie Eskay-Auerbach, James B. Talmage

   Pages 14–16

   DOI: 10.1001/amaguidesnewsletters.2017.MayJun03

   Abstract

   Physicians frequently are asked to assess work ability in individuals with low back pain (LBP) who also require an impairment rating. Physicians may be tempted to base their decisions about the individual's work ability on spinal anatomy/diagnosis as established by imaging, because that may seem objective. However, a review of the current medical literature consistently demonstrates that anatomical abnormalities identified on imaging do not predict functional ability. Rather, recent studies have demonstrated a strong association between the number of symptoms and functional status, on the one hand, and the lack of correlation between findings on imaging and symptoms, on the other hand. For example, a systematic review by Mayo Clinic physicians of 33 published studies in which 3110 asymptomatic adults were imaged using magnetic resonance imaging (MRI) showed that, in middle age when most problematic back pain problems present, roughly half of asymptomatic adults had disc bulges, roughly one-third had disc protrusions, and roughly one-quarter had annular fissures. The authors of the present study also review related studies regarding low back pain and conclude that current scientific knowledge suggests that imaging alone is not useful in predicting function or in assessing future risk. Degenerative changes on imaging are not a sound basis for work restrictions because they do not correlate with risk or capacity.
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