Guides Question and Answer
James B. Talmage
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Sun-related skin disorders are rated, along with all dermatological disorders, using Chapter 8, The Skin, in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) and are based on three factors: the presence of a skin disorder (signs and symptoms); need for treatment; and interference with activities of daily living (ADL). This Case Presentation illustrates some of the challenges that an evaluator new to the rating process may encounter and clarifies that precautionary guidance to reduce sun exposure is not equivalent to interference in ADL and the assignment of impairment. The patient has been a firefighter since 1986, previously worked in construction, lives in Southern California, and surfed recreationally until six or seven years ago. He presents with new lesions of his skin following sun exposure and has been followed by his primary care physician and his dermatologist regarding his basal cell carcinoma and cryosurgeries to treat actinic keratoses. The evaluator determines class 3, 25% impairment, which precludes ADL in the midday sun. The authors note two immediate red flags: Misnaming the AMA Guides is a typical beginner's error, and the evaluation provides no reference to specific criteria or tables even though the State of California uses the fifth edition to rate workers’ compensation cases.

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