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Abstract
Before the publication of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, each chapter focused on a single organ system and provided a description of the diagnostic and evaluative methods for assessing impairment at the organ system level and functional impairment of the whole person. Beginning with the Fourth and continuing into the Fifth Edition, a new chapter focused not on a single organ system but rather on pain. The author of this article takes issue with others who propose that pain should not only be conceptualized as a disabling factor but also as an impairment. Some have argued that, “[d]espite its stated intent, the [AMA] Guides does not maintain a clear focus on functional impairment … it blurs the line between impairment and disability. The [AMA] Guides defines impairment so broadly as to include disability, effectively confusing the 2 concepts.” For these very reasons, argues the author of this article, pain should not be conceptualized as an impairment, and rating schemes should not promote or reinforce inappropriate behavior, for example, by providing a reward for reporting more pain. The latter will lead to more diagnostic testing, more treatment, and more physician-prescribed work absence, culminating in the reinforcement of perceived illness and incapacity.
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Criteria Committee of the New York Heart Association. Diseases of the Heart and Blood Vessels: Nomenclature and Criteria for Disease. 6th ed. Boston, Mass: Little Brown and Co; 1964.
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Office of Motor Carriers. Conference on Cardiac Disorders and Commercial Drivers. Publication No. FHWA-MC-88-040, Washington, DC: Office of Motor Carriers; December 1987. (www.fmcsa.dot.gov/Pdfs/cardiac.pdf)
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The Department of Transportation is about to release a new document (based on an October 2002 consensus conference) on Commercial Drivers and Cardiac Disease that will permit commercial driving with a 6 MET exercise ability (without ischemia), provided that the left ventricle Ejection Fraction is > 40 %.
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Social Security Administration. Disability Evaluation Under Social Security. SSA Publication No. 64-039, Section 4.04; 2001. (www.ssa.gov/disability/professionals/bluebook/2001bluebook.pdf)
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