AMA Guides® Newsletter - Issue Archive

Articles

1. Performing Quality Impairment Evaluations

   Christopher R. Brigham

   Pages 1–3

   DOI: 10.1001/amaguidesnewsletters.1998.JulAug01

   Abstract

   An impairment evaluation aims to produce a report that is clear and consistent with the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, which outlines the three-step process of medical evaluation, analysis of the findings, and comparison of the results with the impairment criteria. This article reviews common errors that can occur in each of these steps. Medical evaluation is the basis for the evaluation of impairment and relies on the patient's medical history; the latter must include adequate background information, specify data sources, document pre-existing status and specifics of the injury, and document history from onset to current status. The medical evaluation should support a report that explains the effects of the medical condition on life activities; whether the medical condition is stable; whether the individual is likely to suffer incapacitation, injury, harm, or further impairment; and whether restrictions or accommodations are warranted. Common errors in this step include determinations of permanency and stability, and raters should be aware that the AMA Guides is used to assess impairment, not disability. Forms from the AMA Guides are appropriate and help mitigate errors. An audit form is included and can help physicians produce consistent, efficient reports.
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2. Tools and Resources: Impairment Evaluation Report Audit

   Pages 4–4

   DOI: 10.1001/amaguidesnewsletters.1998.JulAug02

   Abstract

   Dysphagia refers to the feeling of difficulty in passing food or liquid from the mouth to the stomach and requires rapid neuromuscular coordination not only of the esophagus but also structures in the oral cavity, pharynx, and larynx during a brief cessation of respiration. The swallowing mechanism can be separated into three stages: oral, pharyngeal, and esophageal. Disabilities resulting directly from dysphagia may arise secondary to aspiration, and the ongoing risk of aspiration has several consequences: limited oral intake of solid food and liquids, restriction of the diet (eg, to foods of a certain consistency), need for assistance when eating, and discomfort associated with eating. Evaluation usually includes assessment by a speech-language pathologist and often is supplemented by a modified barium swallow or a fiberoptic endoscopic evaluation of swallowing. The AMA Guides to the Evaluation of Permanent Impairment describes the process for evaluating impairment for dysphagia in Chapter 4, The Nervous System, Chapter 9, Ear, Nose, Throat, and Related Structures, and Chapter 10, The Digestive System. Section 9.3b, Mastication and Deglutition, includes information about the relationship of dietary restrictions to permanent impairment. Impairment for dysphagia is determined by considering the underlying cause for the dysphagia, dietary restrictions, feeding requirements, and complications.
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3. Clinical Update: Dysphagia

   Joseph R. Spiegel, Steven Mandel, Robert T. Sataloff, Judith Creed

   Pages 5–5

   DOI: 10.1001/amaguidesnewsletters.1998.JulAug03

   Abstract

   Physicians are infrequently asked to evaluate an individual with facial disfigurement following an injury because, when the face is injured, typically it heals without any ratable impairment. When a permanent facial disfigurement must be rated, physicians can use Section 9.2 of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). Chapter 9 of the AMA Guides is unique because it deals only with permanent impairment related to the face's structural integrity, which may be only one aspect of a patient's condition that requires an impairment rating. Facial disfigurement may be the result of a complicated process, for example, a burn that involves multiple organ systems, each with a loss of function that requires an impairment rating. These ratings fall into one of four classes: Class 1 is used when the disorder is limited to the cutaneous structures and may involve a scar or abnormal pigmentation in the cutaneous structures of the face. Class 2 involves loss of some significant underlying supporting structure of the face without significant functional loss or major disfigurement such as a depressed orbital rim, frontal bone, or nasal bone. Class 3 indicates loss of a normal anatomic part or area of the face, eg, an eye. A facial disfigurement so severe that it precludes social acceptance is a Class 4 impairment.
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4. Impairment Tutorial: Rating Facial Disfigurement After an Injury

   Marc T. Taylor

   Pages 6–6

   DOI: 10.1001/amaguidesnewsletters.1998.JulAug04

   Abstract

   This article discusses two important cases that involve the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). First, in Vargas v Industrial Com’n of Arizona, a claimant had a pre-existing non–work-related injury to his right knee as well as a work-related injury, and the issue was apportionment of the pre-existing injury. The court held that, under Arizona's statute, the impairment from the pre-existing injury should be subtracted from the current work-related impairment. In the second case, Colorado courts addressed the issue of apportionment in a workers’ compensation claim in which the pre-existing injury was asymptomatic at the time of the work-related injury (Askey v Industrial Claim Appeals Office). In this case, the court held that the worker's benefits should not be reduced to account for an asymptomatic pre-existing condition that could not be rated accurately using the AMA Guides. The AMA Guides bases impairment ratings on anatomic or physiologic loss of function, and if an examinee presents with two or more sequential injuries and calculable impairments, the AMA Guides can be used to apportion between pre-existing and subsequent impairments. Courts often use the AMA Guides to decide statutorily determined benefits and are subject to interpretation by courts and administrative bodies whose interpretations may vary from state to state.
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5. Legal Update: Workers' Compensation Court Decisions on Apportionment

   James J. Mangraviti, Christopher R. Brigham

   Pages 7–8

   DOI: 10.1001/amaguidesnewsletters.1998.JulAug05