AMA Guides® Newsletter - Issue Archive

Articles

1. Do Low-Speed Vehicle Collisions Cause Intervertebral Disc Degeneration or Herniation?

   Rawson L. Wood, Mathew J. Greenston, Charles E. Bain, Charles N. Brooks

   Pages 3–8

   DOI: 10.1001/amaguidesnewsletters.2018.NovDec01

   Abstract

   Complaints of spinal pain are common after motor vehicle collisions (MVCs), and evaluators may be asked whether the collision caused permanent injury to the spine, including aggravating intervertebral disc degeneration (IDD) and/or causing a disc herniation. To determine causality, evaluators can use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) to understand if a low-speed collision caused IDD. Injury causation analysis (ICA) is the scientific method used to analyze the mechanism and magnitude of injury for people who experience an MVC. ICA involves comparing the mechanical forces involved in the incident with the body's injury tolerance. Low back pain (LBP) is a common complaint following MVCs, but the literature regarding automobile collision testing has been compared to the body of evidence regarding real-world collision data and shows that, for low-speed impacts, any injuries are minor and self-limiting. Further, disability due to LBP was predicted by an abnormal baseline psychological test profile or a previously disputed compensation claim. The motions, forces, and accelerations generated in low-speed collisions are less than those encountered in activities of everyday living. ICA suggests that disc degeneration and disc herniations are pre-existing and are not caused by low-speed MVCs. Although the pain caused by a muscle sprain associated with a low-speed collision may prompt imaging studies that show disc pathology, these are coincidental and are not causally related.
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2. Effects of Aging on Impairment Ratings: Part 2: Internal Medicine Issues

   Stephen L. Demeter

   Pages 9–13

   DOI: 10.1001/amaguidesnewsletters.2018.NovDec02

   Abstract

   This is the second of four articles that explore the effects of age-related changed in impairment evaluations according to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth and Sixth Editions; specifically, this article completes the review of the internal medicine sections. With respect to the digestive system, the normal aging process affects gastrointestinal impairment ratings as found in the AMA Guides, Fifth and Sixth Editions, for gastroesophageal reflux disease, peptic ulcer disease, pancreatitis, diverticulitis, irritable bowel syndrome, fecal incontinence, and hemorrhoids. Cancers of the digestive system and infectious hepatitis were reviewed by the National Institutes of Health in The Burden of Digestive Diseases in the United States (2008), which should be reviewed when an impairment rating or apportionment is needed or for an individual with these conditions alleged to be the result of a compensable injury or illness. The normal aging process does not significantly affect the impairment ratings for renal disease (upper urinary tract disease), but, for individuals over 70, an age adjustment should be incorporated into the impairment rating. The AMA Guides, Fifth and Sixth Editions, also do not provide age-related modifications for urinary incontinence, but a rating physician may apply a discretionary apportionment. For diseases of the scrotum, testicles, epididymis, and spermatic cord, as well as for prostatic hypertrophy, neither edition of the AMA Guides makes age-related modifications; neither are modifications because of aging are made for the female reproductive tract, although raters are told to consider the physiological differences.
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3. Symptom Validity Testing

   Lee H. Ensalada

   Pages 14–15

   DOI: 10.1001/amaguidesnewsletters.2018.NovDec03

   Abstract

   Symptom validity testing (SVT), also known as forced-choice testing, is a means of assessing the validity of sensory and memory deficits, including tactile anesthesias, paresthesias, blindness, color blindness, tunnel vision, blurry vision, and deafness. The common feature among these symptoms is a claimed inability to perceive or remember a sensory signal. SVT comprises two elements: a specific ability is assessed by presenting a large number of items in a multiple-choice format, and then the examinee's performance is compared to the statistical likelihood of success based on chance alone. These tests usually present two alternatives; thus the probability of simply guessing the correct response (equivalent to having no ability at all) is 50%. Thus, scores significantly below chance performance indicate that the sensory cues must have been perceived, but the examinee chose not to report the correct answer—alternative explanations are not apparent. SVT also has the capacity to demonstrate that the examinee performed below the probabilities of chance. Scoring below a norm can be explained by fatigue, evaluation anxiety, inattention, or limited intelligence. Scoring below the probabilities of chance alone most likely indicates deliberate deceptions and is evidence of malingering because it provides strong evidence that the examinee received the sensory cues and denied the perception. Even so, malingering must be evaluated from the total clinical context.
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