Questions and Answers November 2021

Abstract Controversy attends use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in defining injured workers’ permanent partial disability benefits: States desire an efficient, nonsubjective way to determine benefits for nonscheduled injuries and are using the AMA Guides to define the extent of disability. Organized labor is concerned that use of the AMA Guides, particularly with modifications, does not yield a fair analysis of an injured worker's disability. From its first issue, The Guides Newsletter emphatically emphasized and clearly stated that impairment percentages derived according to AMA Guides criteria should not be used to make direct financial awards or direct estimates of disability. The insurance industry and organized labor differ about the use of the AMA Guides in defining permanent partial disability (PPD). Insurers support use of the AMA Guides because they seek a uniform system that minimizes subjectivity in determining benefits. Organized labor is particularly concerned about the lack of fairness of directly equating impairment and disability, and if the rating plays a role in defining disability, additional issues also must be considered. More states are likely to use the AMA Guides with incorporation of additional features such as an index to PPD.

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Questions and Answers: Rating Spinal Pain Using the Sixth Edition

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2013.sepoct02 ◽

2013 ◽

Vol 18 (5) ◽

pp. 11-12

Author(s):

Christopher R. Brigham ◽

James B. Talmage ◽

Marjorie Eskay-Auerbach ◽

Charles N. Brooks

Keyword(s):

Spinal Pain ◽

Sixth Edition ◽

Questions And Answers

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Impairment Questions and Answers

Guides Newsletter ◽

10.1001/amaguidesnewsletters.1999.julaug02 ◽

1999 ◽

Vol 4 (4) ◽

pp. 4-4

Keyword(s):

Symptom Validity ◽

Validity Testing ◽

Symptom Validity Testing ◽

Negative Results ◽

Tunnel Vision ◽

Questions And Answers ◽

Blurry Vision ◽

Fatigue Evaluation ◽

Choice Testing ◽

Rule Out

Abstract Symptom validity testing, also known as forced-choice testing, is a way to assess the validity of sensory and memory deficits, including tactile anesthesias, paresthesias, blindness, color blindness, tunnel vision, blurry vision, and deafness—the common feature of which is a claimed inability to perceive or remember a sensory signal. Symptom validity testing 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 with the statistical likelihood of success based on chance alone. Scoring below a norm can be explained in many different ways (eg, fatigue, evaluation anxiety, limited intelligence, and so on), but scoring below the probabilities of chance alone most likely indicates deliberate deception. The positive predictive value of the symptom validity technique likely is quite high because there is no alternative explanation to deliberate distortion when performance is below the probability of chance. The sensitivity of this technique is not likely to be good because, as with a thermometer, positive findings indicate that a problem is present, but negative results do not rule out a problem. Although a compelling conclusion is that the examinee who scores below probabilities is deliberately motivated to perform poorly, malingering must be concluded from the total clinical context.

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Questions and Answers

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2000.marapr02 ◽

2000 ◽

Vol 5 (2) ◽

pp. 3-3

Author(s):

Christopher R. Brigham ◽

James B. Talmage

Keyword(s):

Nervous System ◽

Peripheral Nervous System ◽

Spinal Nerve ◽

Sensory Loss ◽

Residual Symptoms ◽

Additional Information ◽

Questions And Answers ◽

Motor Nerves ◽

Symptoms And Signs ◽

Limited Motion

Abstract Lesions of the peripheral nervous system (PNS), whether due to injury or illness, commonly result in residual symptoms and signs and, hence, permanent impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) describes procedures for rating upper extremity neural deficits in Chapter 3, The Musculoskeletal System, section 3.1k; Chapter 4, The Nervous System, section 4.4 provides additional information and an example. The AMA Guides also divides PNS deficits into sensory and motor and includes pain within the former. The impairment estimates take into account typical manifestations such as limited motion, atrophy, and reflex, trophic, and vasomotor deficits. Lesions of the peripheral nervous system may result in diminished sensation (anesthesia or hypesthesia), abnormal sensation (dysesthesia or paresthesia), or increased sensation (hyperesthesia). Lesions of motor nerves can result in weakness or paralysis of the muscles innervated. Spinal nerve deficits are identified by sensory loss or pain in the dermatome or weakness in the myotome supplied. The steps in estimating brachial plexus impairment are similar to those for spinal and peripheral nerves. Evaluators should take care not to rate the same impairment twice, eg, rating weakness resulting from a peripheral nerve injury and the joss of joint motion due to that weakness.

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