Cover AMA Guides® to the Evaluation of Permanent Impairment, Sixth Edition, 2022

AMA Guides® to the Evaluation of Permanent Impairment, Sixth Edition, 2022

Publisher:
American Medical Association
DOI:
https://doi.org/10.1001/978-1-64016-212-9
ISBN:
9781640162129
Publication Date:
01 Jan 2022
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Summary of Updates to AMA Guides Sixth Edition 2022

  • Language describing the new evidence-based editorial process explains why the latest edition of the AMA Guides is rooted in science and best evidence.
  • Encourages documenting evidence and the standard used to determine the impairment rating in reports.
  • No changes to impairment ratings or methodology.

Chapter 1: Conceptual Foundations and Philosophy

  • Section 1.1 History of the AMA Guides
    • Description of changes: Insertion of paragraph to describe the evolution of the sixth edition of the AMA Guides, including the new evidence-based editorial process and panel.
  • Section 1.2a Previous Criticisms of the AMA Guides
    • Insertion: “New editions of the AMA Guides were unable to be published quickly enough to reflect emergent improvements in science and evidence-based medicine.”
  • Section 1.3b Applications of ICF Model to the AMA Guides, International Appeal and Applications
    • Insertion: “The concept of impairment evaluation as it relates to the ICF model continues to evolve. Incorporation of the biopsychosocial model of health will provide a platform for further research and exploration of these concepts into the future.”
  • Section 1.6 The Case for Simplification and Ease of Application
    • New Section title: Evidence Requirements
    • Description of changes: details the evidence requirements for updating the sixth edition.
  • Section 1.8e History of Clinical Presentation
    • Removed: “…those with minimal or intermittent moderate symptoms, in impairment class 1; and those with constant symptoms that persist despite treatment, in impairment class 4.”
    • Inserted: “...those with mild symptoms will be in class 1; and those with very severe constant symptoms that persist despite treatment will be in impairment class 4.”
  • 1.8g Objective Test Results
    • Insertion: “Each chapter will delineate the key factor of the impairment class within a given grid.”
    • Insertion: “Typically, a combination of the key factor and non-key factors will be used to determine a place within a class and grade, and the key factor may vary within chapters or between chapters.”
  • 1.9 AMA Guides Editorial Process and Digital Delivery (New Section)
    • Description of changes: additional information about the mission and goals of the AMA Guides Editorial Panel and the importance of using the most current evidence-based medicine to complete impairment ratings.
    • Sixth edition methodology will serve as the foundation for all changes to the AMA Guides moving forward.
    • Figure 1.3, AMA Guides Editorial Process is also provided.
  • Minor editorial updates throughout the chapter have been made to improve readability and for clarity.

Chapter 2: Practical Application of the AMA Guides

  • Introduction
    • Description of changes: revised to reflect the evidence-based editorial process and AMA H-365.976
    • Deletion: The Guides is written by medical doctors for medical doctors and others permitted to do impairment evaluations. 
    • Insertion: The AMA Guides is written by physicians for conducting impairment evaluations. Physician is defined as an individual who has received a Doctor of Medicine or a Doctor of Osteopathic Medicine degree or a recognized equivalent physician degree and who would be eligible for an Accreditation Council for Graduate Medical Education (ACGME) residency.
  • Table 2-1 Fundamental Principles of the AMA Guides (#6)
    • Deletion: “Impairment evaluation requires medical knowledge. Physicians duly recognized by an appropriate jurisdiction should perform such assessments within their applicable scope of practice and field of expertise.”
    • Insertion: “Impairment evaluation requires medical knowledge. Physicians, chiropractors, and others permitted to do impairment evaluations recognized by the relevant jurisdiction perform impairment evaluations within their applicable scope of practice and field of expertise and calculate impairment ratings utilizing the AMA Guides.”
  • Section 2.3a Who Performs Impairment Ratings?
    • Deletion: Impairment evaluation requires medical knowledge; therefore, mostly doctors who are qualified in allo pathic or osteopathic medicine or chiropractic medicine use the Guides to evaluate permanent impairment. For the purpose of determining impairment, the appropriate health regulatory agency in a given jurisdiction is the best-suited authority to determine the definition of doctor in regard to who uses the Guides to rate impairment in that jurisdiction.

      It must be emphasized, however, that even though the Guides is mainly written by medical doctors for medical doctors and others permitted to do impairment evaluations, nonphysician evaluators may analyze an impairment evaluation to determine if it was performed in accordance with the Guides.

    • Insertion: Impairment evaluation requires medical knowledge. Physicians, chiropractors, and others recognized by the relevant jurisdiction perform impairment evaluations within their applicable scope of practice and field of expertise and calculate impairment ratings utilizing the AMA Guides. For the purpose of determining impairment, the appropriate health regulatory agency in a given jurisdiction is the best-suited authority to determine who may submit an impairment rating in that jurisdiction.

      It must be emphasized, however, that even though the AMA Guides is mainly written by physicians for conducting impairment evaluations, non-physician evaluators may analyze an impairment evaluation to determine if it was performed in accordance with the AMA Guides.

  • Section 2.6 Impairment Evaluation and the Law
    • Description of changes: inserted language elaborates on the concept that content updates in AMA Guides Sixth 2022 and future editions of the AMA Guides are supported by an evidence-based foundation, upholding the AMA’s commitment to providing information for physicians and patients based on the most current, evidence-based medicine
  • 2.7dConcluding the Report: Use of Evidence-Based Medicine
    • Description of changes: encourages users to acknowledge the standard (eg, edition of the AMA Guides) used to perform the evaluation and impairment rating and the science/evidence used to support recommendations I the report. Specimen language is also offered for consideration for raters to insert into their reports to describe this process.
  • Impairment report template: Standard(s) Used to Determine the Impairment Rating is Offered for Consideration.
  • Minor editorial updates throughout the chapter have been made to improve readability and for clarity.

This page is designed to provide you with easy access to the AMA Guides to the Evaluation of Permanent Impairment 6th Edition, 2022 tables.

Jump to Chapter:

Chapter 1: Conceptual Foundations and Philosophy
Chapter 2: Practical Application of the Guides
Chapter 3: Pain-Related Impairment
Chapter 4: The Cardiovascular System
Chapter 5: The Pulmonary System
Chapter 6: The Digestive System
Chapter 7: The Urinary and Reproductive Systems
Chapter 8: The Skin
Chapter 9: The Hematopoietic System
Chapter 10: The Endocrine System
Chapter 11: Ear, Nose, Throat, and Related System
Chapter 12: The Visual System
Chapter 13: The Central and Peripheral Nervous System
Chapter 14: Mental and Behavioral Disorders
Chapter 15: The Upper Extremities
Chapter 16: The Lower Extremities
Chapter 17: The Spine and Pelvis
Appendix

Chapter 1: Conceptual Foundations and Philosophy
Tables
Table 1-1: Self-Care
Table 1-2: Hierarchy of Study Types
Table 1-3: ICF Codes and Functional Levels
Table 1-4: Sample Impairment Function Classification
Table 1-5: Generic Template for Impairment Classification Grids
Table 1-6: General Principles for Calculating Impairment
Chapter 2: Practical Application of the Guides
Tables
Table 2-1: Fundamental Principles of the Guides
Chapter 3: Pain-Related Impairment
Tables
Table 3-1: Pain-Related Impairment and Whole Person Impairment Based on Pain Disability Questionnaire
Chapter 4: The Cardiovascular System
Tables
Table 4-1: NYHA Functional Classification of Cardiac Disease
Table 4-2: Relationship of METs and Functional Class According to 5 Treadmill Protocols
Table 4-3: Energy Expenditure in METs During Bicycle Ergometry
Table 4-4: Methodology for Determining the Grade in an Impairment Class
Table 4-5: Criteria for Rating Permanent Impairment due to Valvular Heart Disease
Table 4-6: Criteria for Rating Impairment due to Coronary Artery Disease
Table 4-7: Criteria for Rating Impairment due to Cardiomyopathies
Table 4-8: Criteria for Rating Impairment due to Pericardial Heart Disease
Table 4-9: Criteria for Rating Impairment due to Dysrhythmias
Table 4-10: Classification of Blood Pressure for Adults
Table 4-11: Criteria for Rating impairment due to Hypertensive Cardiovascular Disease
Table 4-12: Criteria for Rating Impairment due to Peripheral Vascular Disease – Lower Extremity
Table 4-13: Criteria for Rating Impairment due to Peripheral Vascular Disease – Upper Extremity
Table 4-14: Criteria for Rating Impairment due to Diseases of the Pulmonary Artery
Table 4-15: Cardiac Impairment Evaluation Summary
Chapter 5: The Pulmonary System
Tables
Table 5-1: Impairment Classification of Dyspnea (Adapted)
Table 5-2: Impairment Classification for Prolonged Physical Work Intensity by Oxygen Consumption
Table 5-3: Methodology for Determining the Grade in an Impairment Class
Table 5-4: Criteria for Rating Permanent Impairment due to Pulmonary Dysfunction
Table 5-5: Criteria for Rating Permanent Impairment due to Asthma
Table 5-6: Scale for Judging Capabilities of Subjects With Cancer
Table 5-7: Pulmonary Impairment Evaluation Summary
Chapter 6: The Digestive System
Tables
Table 6-1: Desirable Weights for Men by Height and Body Build
Table 6-2: Desirable Weights for Women by Height and Body Build
Table 6-3: Methodology for Determining the Grade in an Impairment Class
Table 6-4: Criteria for Rating Permanent Impairment due to Upper Digestive Tract (Esophagus, Stomach and Duodenum, Small Intestine, and Pancreas) Disease
Table 6-5: Criteria for Rating Permanent Impairment due to Colonic and Rectal Disorders
Table 6-6: Criteria for Rating Permanent Impairment due to Anal Disease
Table 6-7: Impairments From Surgically Created Stomas
Table 6-8: Criteria for Rating Permanent Impairment due to Liver Disease
Table 6-9: Criteria for Rating Permanent Impairment due to Biliary Tract Disease
Table 6-10: Criteria for Rating Permanent Impairment due to Herniation
Table 6-11: Digestive System Impairment Evaluation Summary
Chapter 7: The Urinary and Reproductive Systems
Tables
Table 7-1: Methodology for Determining the Grade in an Impairment Class
Table 7-2: Criteria for Rating Permanent Impairment due to Upper Urinary Tract Disease
Table 7-3: Criteria for Rating Permanent Impairment due to Urinary Diversion Disorders
Table 7-4: Criteria for Rating Permanent Impairment due to Bladder Disease
Table 7-5: Criteria for Rating Permanent Impairment due to Urethral Disease
Table 7-6: Criteria for Rating Permanent Impairment due to Penile Disease
Table 7-7: Criteria for Rating Permanent Impairment due to Scrotal Disease
Table 7-8: Criteria for Rating Impairment due to Testicular, Epididymal, and Spermatic Cord Disease
Table 7-9: Criteria for Rating Impairment due to Prostate Disease
Table 7-10: Criteria for Rating Permanent Impairment due to Vulval and Vaginal Disease
Table 7-11: Criteria for Rating Permanent Impairment due to Cervical and Uterine Disease
Table 7-12: Criteria for Rating Permanent Impairment due to Fallopian Tube and Ovarian Disease
Table 7-13: Urinary and Reproductive Systems Impairment Evaluation Summary
Chapter 8: The Skin
Tables
Table 8-1: Structure, Functions, and Disorders of the Skin
Table 8-2: Criteria for Rating Permanent Impairment due to Skin Disorders
Table 8-3: Skin Impairment Evaluation Summary
Chapter 9: The Hematopoietic System
Tables
Table 9-1: Karnofsky Performance Status Scale Definitions Rating (%) Criteria
Table 9-2: Eastern Cooperative Oncology Group Performance Status Scale (ECOG-PSS)
Table 9-3: Burden of Treatment Compliance
Table 9-4: Methodology for Determining the Grade in an Impairment Class
Table 9-5: Criteria for Rating Permanent Impairment due to Anemia
Table 9-6: Criteria for Rating Permanent Impairment due to Neutropenia
Table 9-7: Criteria for Rating Permanent Impairment due to the Leukemias
Table 9-8: Criteria for Rating Permanent Impairment due to HIV Disease
Table 9-9: Criteria for Rating Impairment due to Platelet Disorders
Table 9-10: Criteria for Rating Impairment due to the Hemophilias
Table 9-11: Criteria for Rating Impairment due to Other Bleeding Disorders
Table 9-12: Criteria for Rating Impairment due to Thrombotic Disorders
Table 9-13: Criteria for Rating Impairment due to Lymphoma and Metastatic Disease
Table 9-14: Hematologic Impairment Evaluation Summary
Chapter 10: The Endocrine System
Tables
Table 10-1: Methodology for Determining the Grade in an Impairment Class
Table 10-2a: Enteral, Intranasal, and Topical Medications
Table 10-2b: Parenteral Medications
Table 10-3: Points Assigned for Dietary Modification
Table 10-4: Procedure-Based Points
Table 10-5: Criteria for Rating Impairment due to Disorders of the Hypothalamic-Pituitary Axis
Table 10-6: Criteria for Rating Impairment due to Thyroid Abnormalities
Table 10-7: Criteria for Rating Impairment due to Disorders of the Parathyroids
Table 10-8: Criteria for Rating Impairment due to Disorders of the Adrenal Cortex
Table 10-9: Criteria for Rating Impairment due to Disorders of the Adrenal Medulla
Table 10-10: Criteria for Rating Impairment due to Diabetes Mellitus
Table 10-11: Criteria for Rating Impairment due to Hypoglycemia
Table 10-12: Criteria for Rating Impairment due to Gonadal Disorders
Table 10-13: Criteria for Rating Impairment due to Mammary Disorders
Table 10-14: Criteria for Rating Impairment due to Metabolic Bone Disease
Table 10-15: Endocrine System Impairment Evaluation Summary
Chapter 11: Ear, Nose, Throat, and Related Structures
Tables
Table 11-1: Monaural Hearing Loss and Impairment
Table 11-2: Computation of Binaural Hearing Impairment
Table 11-3: Relationship of Binaural Hearing Impairment to Impairment of the Whole Person
Table 11-4: Criteria for Rating Impairments due to Vestibular Disorders
Table 11-5: Criteria for Rating Impairment due to Facial Disorders and/or Disfigurement
Table 11-6: Criteria for Rating Impairment due to Air Passage Deficits
Table 11-7: Impairments of Mastication and Deglutition: Relationship of Dietary Restrictions to Permanent Impairment
Table 11-8: Criteria for Rating Voice and Speech Impairment
Chapter 12: The Visual System
Tables
Table 12-1: Calculation Steps for the Visual System
Table 12-2: Impairment of Visual Acuity
Table 12-3: Calculation of the Acuity-Related Impairment Rating
Table 12-4: Classification of Impairment of Visual Acuity
Table 12-5: Impairment of Visual Field
Table 12-6: Conversion of Field Radius to Field Score
Table 12-7: Calculation of the Visual Field–Related Impairment Rating
Table 12-8: Classification of Impairment of Visual Field
Table 12-9: Correction for Central Scotomata
Table 12-10: Classification of Impairment of the Visual System and of the Whole Person
Table 12-11: Determination of Reading Acuity and Impairment Rating, Using Letter Size and Viewing Distance
Chapter 13: The Central and Peripheral Nervous System
Tables
Table 13-1: Summary of Chapters Used to Rate Various Neurologic Disorders
Table 13-2: Activities of Daily Living
Table 13-3: Neurologic Impairments That Are Combined With the Most Severe Cerebral Impairment
Table 13-4: Criteria for Rating Impairment of Consciousness and Awareness
Table 13-5: Criteria for Rating Impairment due to Episodic Loss of Consciousness or Awareness
Table 13-6: Criteria for Rating Impairment due to Sleep and Arousal Disorders
Table 13-7: Mental Status Exam for the Neurologically Impaired Patient
Table 13-8: Criteria for Rating Neurologic Impairment due to Alteration in Mental Status, Cognition, and Highest Integrative Function (MSCHIF)
Table 13-9: Criteria for Rating Impairment due to Aphasia or Dysphasia
Table 13-10: Global Assessment of Functioning (GAF) Impairment Score
Table 13-11: Criteria for Rating Impairments of the Upper Extremities due to CNS Dysfunction
Table 13-12: Criteria for Rating Impairments due to Station and Gait Disorders
Table 13-13: Criteria for Rating the Neurogenic Bowel
Table 13-14: Criteria for Rating the Neurogenic Bladder
Table 13-15: Criteria for Rating Neurogenic Sexual Dysfunction
Table 13-16: Criteria for Rating Neurogenic Respiratory Dysfunction
Table 13-17: Dysesthetic Pain Secondary to Peripheral Neuropathy or Spinal Cord Injury
Table 13-18: Grading System for Rating Impairment due to Migraine Headache
Table 13-19: Criteria for Rating Trigeminal or Glossopharyngeal Neuralgia
Table 13-20: Criteria for Rating Miscellaneous Peripheral Nerves
Chapter 14: Mental and Behavioral Disorders
Tables
Table 14-1: Mental Status Examination
Table 14-2: Selected Psychological Assessment Tools in Adults
Table 14-3: Suggestions for the Mental and Behavioral Disorders Independent Medical Examination
Table 14-4: Functional Impairment Scales for Patients With Mental and Behavioral Disorders (M&BDs)
Table 14-5: Factors That May Affect Motivation
Table 14-6: Characteristics Suggestive of the Need to Evaluate for Malingering
Table 14-7: Brief Psychiatric Rating Scale Form
Table 14-8: Impairment Score of Brief Psychiatric Rating Scale
Table 14-9: Self-Care, Personal Hygiene, and Activities of Daily Living
Table 14-10: Role Functioning, Social and Recreational Activities
Table 14-11: Travel
Table 14-12: Interpersonal Relationships
Table 14-13: Concentration, Persistence, and Pace
Table 14-14: Resilience and Employability
Table 14-15: Impairment Score of Psychiatric Impairment Rating Scale
Chapter 15: The Upper Extremities
Tables
Table 15-1: Definition of Impairment Classes
Table 15-2: Digit Regional Grid: Digit Impairments
Table 15-3: Wrist Regional Grid: Upper Extremity Impairments
Table 15-4: Elbow Regional Grid: Upper Extremity Impairments
Table 15-5: Shoulder Regional Grid: Upper Extremity Impairments
Table 15-6: Adjustment Grid: Summary
Table 15-7: Functional History Adjustment: Upper Extremities
Table 15-8: Physical Examination Adjustment: Upper Extremities
Table 15-9: Clinical Studies Adjustment: Upper Extremities
Table 15-10: Methodology for Determining the Grade in an Impairment Class
Table 15-11: Impairment Values Calculated From Upper Extremity Impairment
Table 15-12: Impairment Values Calculated From Digit Impairment
Table 15-13: Monofilament Test Criteria
Table 15-14: Sensory and Motor Severity
Table 15-15: Sensory Quality Impairment Classification
Table 15-16: Digit Impairment for Transverse and Longitudinal Sensory Losses in Thumb and Little Finger Based on Percent of Digital Length Involved
Table 15-17: Digit Impairment for Transverse and Longitudinal Sensory Losses in Index, Middle, and Ring Fingers Based on Percent of Digital Length Involved
Table 15-18: Impairment for Sensory Only Peripheral Nerve Injury
Table 15-19: Origins and Functions of Peripheral Nerves of Upper Extremity Emanating From Brachial Plexus
Table 15-20: Brachial Plexus Impairment: Upper Extremity Impairments
Table 15-21: Peripheral Nerve Impairment: Upper Extremity Impairments
Table 15-22: Activities of Daily Living (ADLs)
Table 15-23: Entrapment/Compression Neuropathy Impairment
Table 15-24: Diagnostic Criteria for Complex Regional Pain Syndrome
Table 15-25: Objective Diagnostic Criteria Points for Complex Regional Pain Syndrome
Table 15-26: Complex Regional Pain Syndrome (Type I): Upper Extremity Impairments
Table 15-27: Level of Amputation
Table 15-28: Impairment for Upper Limb Amputation at Various Levels
Table 15-29: Amputation Impairment
Table 15-30: Thumb Range of Motion
Table 15-31: Finger Range of Motion
Table 15-32: Wrist Range of Motion
Table 15-33: Elbow/Forearm Range of Motion
Table 15-34: Shoulder Range of Motion
Table 15-35: Range of Motion Grade Modifiers
Table 15-36: Functional History Grade Adjustment: Range of Motion
Table 15-37: Activities of Daily Living Questionnaire
Table 15-38: ADLs Questionnaire Evaluation
Table 15-39: Comparison Between QuickDASH and ADL Questionnaires
Table 15-40: Self-Report Functional Assessment Measures
Chapter 16: The Lower Extremities
Tables
Table 16-1: Definition of Impairment Classes
Table 16-2: Foot and Ankle Regional Grid – Lower Extremity Impairments
Table 16-3: Knee Regional Grid – Lower Extremity Impairments
Table 16-4: Hip Regional Grid – Lower Extremity Impairments
Table 16-5: Adjustment Grid: Summary
Table 16-6: Functional History Adjustment – Lower Extremities
Table 16-7: Physical Examination Adjustment – Lower Extremities
Table 16-8: Clinical Studies Adjustment – Lower Extremities
Table 16-9: Methodology for Determining the Grade in an Impairment Class
Table 16-10: Impairment Values Calculated From Lower Extremity Impairment
Table 16-11: Sensory and Motor Severity
Table 16-12: Peripheral Nerve Impairment – Lower Extremity Impairments
Table 16-13: Diagnostic Criteria for Complex Regional Pain Syndrome
Table 16-14: Objective Diagnostic Criteria Points for Complex Regional Pain Syndrome
Table 16-15: Complex Regional Pain Syndrome (Type I) – Lower Extremity Impairments
Table 16-16: Amputation Impairment
Table 16-17: Functional History Net Modifier
Table 16-18: Lesser Toe Impairments
Table 16-19: Greater Toe Impairments
Table 16-20: Hindfoot Motion Impairments
Table 16-21: Ankle or Hindfoot Deformity Impairments
Table 16-22: Ankle Motion Impairments
Table 16-23: Knee Motion Impairments
Table 16-24: Hip Motion Impairments – Lower Extremity Impairment
Table 16-25: Range of Motion ICF Classification
Chapter 17: The Spine and Pelvis
Tables
Table 17-1: Definition of Impairment Classes and Impairment Ranges
Table 17-2: Cervical Spine Regional Grid: Spine Impairments
Table 17-3: Thoracic Spine Regional Grid: Spine Impairments
Table 17-4: Lumbar Spine Regional Grid: Spine Impairments
Table 17-5: Adjustment Grid: Summary
Table 17-6: Functional History Adjustment: Spine
Table 17-7: Physical Examination Adjustment: Spine
Table 17-8: Common Radicular Syndromes
Table 17-9: Clinical Studies Adjustment: Spine
Table 17-10: Methodology for Determining the Grade in an Impairment Class
Table 17-11: Diagnosis-Based Impairment Grid: Pelvis
Table 17-12: Functional History Adjustment: Pelvis
Table 17-13: Physical Examination Adjustment: Pelvis
Table 17-14: Clinical Studies Adjustment: Pelvis
Table 17-A: PDQ Scoring

Appendix

Combined Values Table
Burden of Treatment Compliance
B-1: Burden of Treatment Compliance
B-2a: Oral, Intranasal, Ocular, Skin
B-2b: Inhaled, Rectal
B-2c: Points for Subcutaneous, IM, Intradermal, IV, and Intracavitary Medication
B-3: Points Assigned For Dietary Modification
B-4: Points Assigned for Procedures

 

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