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What’s New to AMA Guides Sixth Edition 2023

Summary of Updates

  • Chapter 11: No Changes to Impairment Ratings 
  • Chapter 13:  Changes to Impairment Ratings
  • Chapter 15: Minimal impact to Impairment Ratings; encourages use of the DBI method over ROM
  • AMA Guides Sixth 2023 Errata (link)   

Chapter 11: Ear, Nose, Throat, and Related Structures

  • 11.2g Equilibrium 
    • Inclusion of videonystagmography
    • Addition of Rotary Chair Testing 

  • 11.4b Mastication and Deglutition 
    • Text added: Dysphagia may be caused by structural, neuromuscular, neoplastic and other maladies. Oropharyngeal tumors must be ruled out and may occur even in young people, especially in association with human papilloma virus (HPV) infection
    • New dysphagia example

Chapter 13: The Nervous System

Content has been extensively re-written to better adhere to the principles of the AMA Guides, Sixth Edition by promoting the concept of Diagnosis Based Impairment. The structure of the chapter has changes and the way impairment ratings are performed has changed as well. 

Synopses of changes include, but are not limited to:

  • Change of chapter title from Central and Peripheral Nervous System to The Nervous System
  • Conformity of tables with all other Guides chapters
  • Identification of a Key Factor: Effect on ADLs consistent with known natural history of the diagnosis
  • Introduction of Grades within Classes along with Grade Modifiers
  • 3-Grade system with Grade A as the foundation
  • BOTC and adaptive measures can be used to Adjust Grade within Class
  • Update of the following Tables in conformity to the Guides Principle of Simplicity:
    To maintain consistency with Chapter 14, The GAF has been incorporated into the MSCHIF as the MSCHIF-E; Aphasia has been incorporated into the Mental Status Examination within the MSCHIF-E; Modifies Episodic Disorders of Consciousness into Episodic Disorders; Consolidates 3 Tables on Pain into one (Neuropathic Pain); Defers Central Sleep Disorders to Chapter 14, consistent with the DSM-5
  • Creation of the QuickView Worksheet to improve Inter-Rater Reliability
  • Creation of a BOTC that is not burdensome on the evaluator

Chapter 15: The Upper Extremities

  • Tables 15-2, 15-3, 15-4 and 15-5
    • The words “with normal motion” be removed from all sections in which it appears; elimination of the footnote from the DBI tables that says: “*If motion loss is present, this impairment may alternatively be assessed using Section 15.7, Range of Motion Impairment. A range of motion impairment stands alone and is not combined with diagnosis impairment.”
  • Section 15-7 (and 15-3b) 
    • Edited to reinforce DBI as preferred method, but, when presented with decreased ROM, a rater can consider that as an alternative method when the impairment isn’t able to be rated with the DBI paradigm.



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