AMA Guides, Sixth Edition: Skin Impairment, An Overview

2018 ◽  
Vol 23 (3) ◽  
pp. 3-4
Author(s):  
Jay Blaisdell ◽  
James B. Talmage
Keyword(s):  
Physical Examination ◽  
Diagnostic Test ◽  
Common Source ◽  
Key Factors ◽  
Sixth Edition ◽  
Objective Evidence ◽  
Whole Person ◽  
Key Factor ◽  
The Face ◽  
History Of

Abstract The most common source of occupational skin disease is contact dermatitis, an inflammation caused by exposure to an allergen. Whenever possible, the evaluating physician should rely on objective evidence such as lichenification, excoriation, and hyperpigmentation rather than subjective complaints. Patch testing, biopsy, and sensory discrimination tests are reliable tools at the evaluating physician's disposal. Disfigurements of the face are rated using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, Section 11.3, The Face, and Chapter 8, The Skin, is used for all other skin impairments. The evaluating physician records the history of the injury, evaluates the patient, and, in consultation with Table 8-3, notes any objective clinical studies to diagnose the pathology. The functional history, physical examination findings, and diagnostic test findings values then are assigned using Table 8-2; the functional history acts as the key factor and determines the patient's impairment class, physical examination, and diagnostic test findings, each acting as non-key factors, or modifiers. Finally, the non-key factors are used to modify the impairment rating from its default value within its impairment class, and the result is the final skin impairment rating expressed as whole person impairment. Chapter 8 is used only rarely in impairment rating in workers’ compensation cases, and examiners should study the chapter carefully before using it.

Hernia Impairment Ratings and the AMA Guides, Sixth Edition

2016 ◽  
Vol 21 (1) ◽  
pp. 14-14
Author(s):  
Blaisdell Jay ◽  
James Talmage
Keyword(s):  
Abdominal Wall ◽  
Abdominal Pressure ◽  
Key Factors ◽  
Sixth Edition ◽  
Hernia Formation ◽  
Increased Risk ◽  
Whole Person ◽  
Key Factor ◽  
The Many ◽  
Physical Findings

Abstract Of the many types of abdominal wall hernias, inguinal hernias are, by far, the most common type and typically present in males in workers’ compensation cases who report the cause as heavy lifting. The AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, indicates that genetics (family history) is the strongest risk factor. Conditions that chronically increase intra-abdominal pressure (eg, obesity, ascites, or pregnancy) and smoking are statistically associated with abdominal wall hernias, but no good studies show an increased risk of hernia formation in laborers. Abdominal hernias with palpable defects or protrusions usually are corrected with surgery, and the outcome typically warrants an impairment of 0%. In the AMA Guides, Sixth Edition, Section 6.6, Hernias, and Table 6-10, Criteria for Rating Permanent Impairment Due to Hernias, are used for ratings. The rating scheme in the internal medicine chapters differs from that found in the musculoskeletal chapters because the rater uses a key factor of two of three potential variables—history, physical findings, and objective findings—to select the impairment class. Like the grade modifiers in the musculoskeletal chapters, the other variables (other than the key factors) then are used to modify the impairment rating within the impairment class. Most hernias are not due to injury and result in 0% whole person permanent impairment after repair.

Nonspecific Chronic Back Pain: Sixth Edition Approaches

2019 ◽  
Vol 24 (5) ◽  
pp. 14-15
Author(s):  
Jay Blaisdell ◽  
James B. Talmage
Keyword(s):  
Back Pain ◽  
Chronic Back Pain ◽  
Intervertebral Disk ◽  
Key Factors ◽  
Sixth Edition ◽  
Whole Person ◽  
Class 1 ◽  
A Cell ◽  
Intervertebral Disk Herniation ◽  
The Individual

Abstract Ratings for “non-specific chronic, or chronic reoccurring, back pain” are based on the diagnosis-based impairment method whereby an impairment class, usually representing a range of impairment values within a cell of a grid, is selected by diagnosis and “specific criteria” (key factors). Within the impairment class, the default impairment value then can be modified using non-key factors or “grade modifiers” such as functional history, physical examination, and clinical studies using the net adjustment formula. The diagnosis of “nonspecific chronic, or chronic reoccurring, back pain” can be rated in class 0 and 1; the former has a default value of 0%, and the latter has a default value of 2% before any modifications. The key concept here is that the physician believes that the patient is experiencing pain, yet there are no related objective findings, most notably radiculopathy as distinguished from “nonverifiable radicular complaints.” If the individual is found not to have radiculopathy and the medical record shows that the patient has never had clinically verifiable radiculopathy, then the diagnosis of “intervertebral disk herniation and/or AOMSI [alteration of motion segment integrity] cannot be used.” If the patient is asymptomatic at maximum medical improvement, then impairment Class 0 should be chosen, not Class 1; a final whole person impairment rating of 1% indicates incorrect use of the methodology.

scholarly journals Growing Together: Advancing Networks for Service-learning Actors in Asia

2018 ◽  
Vol 59 ◽  
pp. 01030
Author(s):  
Wai Ching Angela Wong
Keyword(s):  
Higher Education ◽  
Service Learning ◽  
Affective Learning ◽  
Community Members ◽  
Higher Education System ◽  
Whole Person ◽  
Learning Programs ◽  
The Face ◽  
History Of ◽  
Whole Person Education

This paper traces the history of United Board‘s engagement with service-learning through higher education in Asia and reflects on the recent discussion about the relevancy of service-learning activities to today‘s higher education system. Through a close review of the experience shared in recent projects sponsored and organized by United Board in the last five years, service learners from colleges and universities around Asia all testified an process that deepens both cognitive and affective learning, generating in service-learning actors-faculty, students and community members-a connection that could inspire and sustain their vision and passion for life. Despite the seemingly still marginalized status of service learning programs and faculty in most higher education institutions, educators believing in whole person education only find service-learning ever more important in the face of higher education that has been increasingly trapped by the ranking race.

Cardiovascular Impairment Evaluation: Sixth Edition

2015 ◽  
Vol 20 (5) ◽  
pp. 12-14
Author(s):  
James B. Talmage ◽  
Jay Blaisdell
Keyword(s):  
Heart Disease ◽  
Valvular Heart Disease ◽  
Vascular Diseases ◽  
Objective Test ◽  
Test Results ◽  
Key Factors ◽  
Sixth Edition ◽  
Key Factor ◽  
Artery Disease ◽  
Physical Findings

Abstract To assess medical impairments, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) divides cardiovascular diseases into the following eight groups, each of which has its own grid: valvular heart disease; coronary artery disease; cardiomyopathies, pericardial heart disease, dysrhythmias, hypertensive cardiovascular disease, vascular diseases affecting the extremities, and diseases of the pulmonary artery. An accompanying table shows the criteria for rating permanent impairment due to valvular heart disease. Within the grids, the rows are divided into three main impairment variables: history, physical findings, and objective test results. The latter are essential in assigning cardiovascular impairment ratings. The AMA Guides names the objective test results variable as the key factor to underscore its role in assigning the impairment class in the cardiovascular chapter. For cardiovascular impairments, objective test results are always used to place the injury in its impairment class; therefore, objective test results are never used to modify the rating once the evaluator chooses the impairment class. Not all internal medicine chapters designate objective test results as the key factor, but all use one key factor that is clearly indicated in a footnote and one or two non-key factors. This rating scheme emphasizes objective test results, history, and physical findings and avoids incorporating variables twice.

Rating Knee Impairments

2018 ◽  
Vol 23 (1) ◽  
pp. 14-16
Author(s):  
Jay Blaisdell ◽  
James Talmage
Keyword(s):  
Lower Extremity ◽  
Physical Examination ◽  
Range Of Motion ◽  
Patellofemoral Pain ◽  
Sixth Edition ◽  
Whole Person ◽  
Causation Analysis

Abstract Workers who kneel for major portions of their workday (eg, floor and roof installers) may be prone to inflammation of the knee bursae and patellofemoral pain. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), range-of-motion (ROM) and diagnosis-based impairment (DBI) are the two possible stand-alone methods for rating knee impairment. The ROM method was widely used in previous editions of the AMA Guides, but at present DBI is the method of choice for calculating impairment. To rate knee impairment using the DBI method, the physician first chooses the appropriate diagnosis from the Knee Regional Grid in the AMA Guides, Sixth Edition. Next, the physician chooses the appropriate impairment class for the diagnosis and then selects the appropriate grade modifiers. The physician applies the net adjustment formula to determine lower extremity impairment and finally converts the final lower extremity impairment to whole person impairment. Two or more conditions often are found in the knees and require causation analysis in which the physician should choose the single causally related diagnosis that will yield the highest impairment rating. Modifiers should be chosen based on reliable findings that have not been used previously to assign either the diagnosis or impairment class. The ROM method can be used to select the physical examination grade modifier or as a stand-alone rating if the physician offers a rationale that is supported by the AMA Guides.

AMA Guides, Sixth Edition: Spinal Impairment Case Examples

2014 ◽  
Vol 19 (6) ◽  
pp. 8-12
Author(s):  
Jeffrey Hazlewood ◽  
James B. Talmage ◽  
Marjorie Eskay-Auerbach
Keyword(s):  
Radicular Pain ◽  
Leg Pain ◽  
Case Examples ◽  
Sixth Edition ◽  
Whole Person ◽  
History Of ◽  
Chemical Irritation ◽  
History Of Pain ◽  
Pain Reports ◽  
Herniated Discs

Abstract Chapter 17, The Spine and Pelvis, of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, is used frequently when determining an individual's permanent impairment rating at maximum medical improvement (MMI). Frequently, ratings for diagnoses of “nonverifiable back pain,” herniated discs, nonverifiable radicular pain, and radiculopathy are requested. Definitions of terminology used in the AMA Guides may differ from those used by some physicians when they see patients, and evaluators should use terminology that is consistent with that of the AMA Guides. For example, for the purposes of the AMA Guides, radiculopathy is defined as “significant alteration in the function of a single or multiple nerve roots and is usually caused by mechanical or chemical irritation of one or several nerves.” This article presents fifteen cases, the whole person impairment associated with each case, and a discussion of the process whereby the rating was obtained. Accurate and fair ratings of common cases of injury-related back and leg pain require a thorough knowledge of the definitions outlined in the AMA Guides, Sixth Edition, as well as thorough knowledge of the peripheral nervous system. Also, an accurate and detailed subjective history of pain reports (including true “radicular” referral patterns) and objective physical examination, as well as a review of the medical records and previous documentations, are essential.

A Case of Unrelenting Facial Swelling

2022 ◽  
pp. 074880682110701
Author(s):  
Lindsay Y. Chun ◽  
Paul O. Phelps
Keyword(s):  
Case Report ◽  
Physical Examination ◽  
Facial Palsy ◽  
Radiographic Imaging ◽  
Presenting Symptoms ◽  
Difficult Diagnosis ◽  
Facial Swelling ◽  
The Face ◽  
History Of ◽  
Patient’S History

Melkersson-Rosenthal syndrome (MRS) is an uncommon disorder with presenting symptoms that typically involve the face and orofacial structures. It is a difficult diagnosis to make, as it may present with a protracted course of seemingly unrelated dermatological, ocular, and neurological findings. This case report reviews the presentation, workup, and diagnosis of a 75-year-old woman who presented with orofacial swelling, facial palsy, and tongue fissuring that had intermittently recurred over 10 years without a unifying diagnosis. Extensive medical history, photography, laboratory workup, and radiographic imaging were performed to identify the diagnosis of MRS in this patient. Our case highlights the challenge and importance of critically evaluating and consolidating a patient’s history of their present illness, physical examination, and ancillary testing to successfully establish a unifying diagnosis, especially when the diagnosis is relatively rare and diverse in its range of affected populations and symptomatology.

Rating Spinal Stenosis: AMA Guides Sixth Edition Case Example

2010 ◽  
Vol 15 (5) ◽  
pp. 12-13
Author(s):  
Marjorie Eskay-Auerbach
Keyword(s):  
Lumbar Spine ◽  
Spinal Stenosis ◽  
Cauda Equina ◽  
Spinal Nerve ◽  
Neurogenic Claudication ◽  
Key Factors ◽  
Nerve Roots ◽  
Sixth Edition ◽  
Whole Person ◽  
Class 1

Abstract Spinal stenosis refers to narrowing of the spinal canal that may result in compression of the spinal cord, or cauda equina. The most common type of spinal stenosis is degenerative stenosis associated with the natural process of aging. In the lumbar spine, the narrowing may result in compression of spinal nerve roots, causing a constellation of symptoms that may include lower pack pain, neurogenic claudication, and lower extremity pain. This case illustrates the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition process of assessing impairment for spinal stenosis. The case involves a 54-year-old male truck driver whose lumbar spine was injured when he unloaded and lifted a tire; he underwent lumbar decompression at L3-4 and L4-5, and fourteen months after surgery was evaluated as being at maximum medical improvement, was able to walk, and could void spontaneously. In a one-page final medical report, the patient's physician hand wrote a note assigning 29% whole person impairment without a medical rationale to support the rating. The author of this case example first notes that the medical reporting does not support placing this patient in class 4, and the examinee's condition is most consistent with a class 1 rating for spinal stenosis. Using Section 17.3, Adjustment Grids and Grade Modifiers: Non-Key Factors, an evaluator would conclude a grade B, 6% whole person impairment for the lumbar spine.

State-by-State Use of AMA Guides

2019 ◽  
Vol 24 (5) ◽  
pp. 3-7, 16
Keyword(s):  
Expert Testimony ◽  
Narrow Range ◽  
The United States ◽  
Workers Compensation ◽  
Federal Employees ◽  
Permanent Disability ◽  
Sixth Edition ◽  
History Of ◽  
Canadian Provinces

Abstract This article presents a history of the origins and development of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), from the publication of an article titled “A Guide to the Evaluation of Permanent Impairment of the Extremities and Back” (1958) until a compendium of thirteen guides was published in book form in 1971. The most recent, sixth edition, appeared in 2008. Over time, the AMA Guides has been widely used by US states for workers’ compensation and also by the Federal Employees Compensation Act, the Longshore and Harbor Workers’ Compensation Act, as well as by Canadian provinces and other jurisdictions around the world. In the United States, almost twenty states have developed some form of their own impairment rating system, but some have a narrow range and scope and advise evaluators to consult the AMA Guides for a final determination of permanent disability. An evaluator's impairment evaluation report should clearly document the rater's review of prior medical and treatment records, clinical evaluation, analysis of the findings, and a discussion of how the final impairment rating was calculated. The resulting report is the rating physician's expert testimony to help adjudicate the claim. A table shows the edition of the AMA Guides used in each state and the enabling statute/code, with comments.

Spine Impairment Evaluation: Sixth Edition Approaches

2009 ◽  
Vol 14 (1) ◽  
pp. 1-5
Author(s):  
Craig Uejo ◽  
Marjorie Eskay-Auerbach ◽  
Christopher R. Brigham
Keyword(s):  
Functional Status ◽  
Spinal Injury ◽  
Current Medical ◽  
Clinical Testing ◽  
Medical Evidence ◽  
Sixth Edition ◽  
Whole Person ◽  
Rating Process ◽  
Impairment Ratings ◽  
Class Assignment

Abstract Evaluators who use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, should understand the significant changes that have occurred (as well as the Clarifications and Corrections) in impairment ratings for disorders of the cervical spine, thoracic spine, lumbar spine, and pelvis. The new methodology is an expansion of the Diagnosis-related estimates (DRE) method used in the fifth edition, but the criteria for defining impairment are revised, and the impairment value within a class is refined by information related to functional status, physical examination findings, and the results of clinical testing. Because current medical evidence does not support range-of-motion (ROM) measurements of the spine as a reliable indicator of specific pathology or permanent functional status, ROM is no longer used as a basis for defining impairment. The DRE method should standardize and simplify the rating process, improve validity, and provide a more uniform methodology. Table 1 shows examples of spinal injury impairment rating (according to region of the spine and category, with comments about the diagnosis and the resulting class assignment); Table 2 shows examples of spine impairment by region of the spine, class, diagnosis, and associated whole person impairment ratings form the sixth and fifth editions of the AMA Guides.

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