AMA Guides® Newsletter - Issue Archive
Volume 7 (2002): Issue 2 (Mar) < Previous Issue Next Issue >
Articles
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Combining Values
Christopher R. Brigham
Pages 1–4, 12
DOI: 10.1001/amaguidesnewsletters.2002.MarApr01
AbstractTo account for the effects of multiple impairments, evaluating physicians must provide a summary value that combines multiple impairments so the whole person impairment is equal to or less than the sum of all the individual impairment values. A common error is to add values that should be combined and typically results in an inflated rating. The Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, includes instructions that guide physicians about combining impairment ratings. For example, impairment values within a region generally are combined and converted to a whole person permanent impairment before combination with the results from other regions (exceptions include certain impairments of the spine and extremities). When they combine three or more values, physicians should select and combine the two lowest values; this value is combined with the third value to yield the total value. Upper extremity impairment ratings are combined based on the principle that a second and each succeeding impairment applies not to the whole unit (eg, whole finger) but only to the part that remains (eg, proximal phalanx). Physicians who combine lower extremity impairments usually use only one evaluation method, but, if more than one method is used, the physician should use the Combined Values Chart. -
Impairment Tutorial: Impairment Evaluation of Ear, Nose, Throat, and Related Structures: Fifth Edition Revisions
Kathryn Mueller, Christopher R. Brigham
Pages 5–6, 11
DOI: 10.1001/amaguidesnewsletters.2002.MarApr02
AbstractChapter 11, Ear, Nose, Throat, and Related Structures of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, includes a new section on voice impairment, a new table on vestibular disorders, and information regarding combined facial disorders and disfigurements. Impairments are based on anatomic, physiological, and functional approaches and involve the assessment of subjective information (eg, statements provided by the patient) and objective factors determined by clinical examination or functional tests. The rating of hearing loss is unchanged from the Fourth Edition in the AMA Guides, Fifth Edition, and tables guide the conversion of monoauricular and binaural hearing impairments into whole person impairments. A tinnitus rating can be combined with the binaural hearing impairment loss before conversion to a whole person permanent impairment. Total disfigurement of the face can be graded between 16% and 50%; a table guides evaluators in rating facial disorders or disfigurement. Impairments of the nose, throat, and related structures include respiration, mastication, deglutition, olfaction and taste, speech, and voice. Although hearing loss is measured using anatomic, physiological, and functional approaches, many other assessments in Chapter 11 are based on interference in the activities of daily living, and the examiner must perform a careful assessment and apply the criteria in the AMA Guides. -
Legal Update: Use of Impairment as a Threshold Determinate for Disability
Christopher R. Brigham
Pages 7–10
DOI: 10.1001/amaguidesnewsletters.2002.MarApr03
AbstractWorkers’ compensation jurisdictions use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), in various ways, including as a proxy for disability, either as a direct correlate or as a threshold indicator. The AMA Guides clearly states that it should not be used for direct estimates of work ability: “it is inappropriate to use the Guides’ criteria or rating to make direct estimates of work disability.” The Maine Supreme Court ruled on two cases in which the resolution depended on the critical question of what impairment was being rated—that due to the injury or to all impairment. The court found that statutory language regarding personal injury may include a pre-existing condition when the work injury aggravates, accelerates, or combines with the pre-existing condition in a significant manner. The Commonwealth of Pennsylvania also uses impairment as a threshold to determine if an employee is totally disabled: Act 57 requires employees who have received total disability benefits for 104 weeks to submit to an impairment rating evaluation. The actions in both states raise questions about the reasonableness of using impairment to determine disability: What is the average extent of impairment among the working population? How can multisystem impairment be rated effectively? Few physicians have been trained in the use of the AMA Guides, and fewer understand the complexities of multisystem rating.