Abstract
The Centers for Disease Control has defined long COVID—or post–COVID-19 conditions—as a clinical syndrome reflecting a wide range of new, persistent, or recurring health problems experienced by individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 [COVID-19]). What is known is that symptoms in these individuals diminish with time. It is unclear how long it takes to achieve maximum medical improvement. This article addresses the cardiac manifestations (including the pulmonary vascular and peripheral vascular manifestations) of long COVID. Emphasis is placed on recent articles (published in the last year) and issues relating to impairment evaluations.
Abstract
There is an association between obesity and restriction on pulmonary function testing when relying on the forced vital capacity (FVC) as the defining parameter for restriction. Body mass index (BMI) may not be the best measure of obesity, but it is the most commonly used. Multiple examples of regression formulae have been developed to explain the relationship between obesity and restriction, but these may be too complicated for general use. This article reviews the medical literature concerning this association.
Abstract
Independent medical examinations (IMEs) are elective evaluations of clinical conditions and differ from a clinical consultation in several important ways. They are conducted in many medicolegal contexts and are performed by a regulated health professional who is not the treating health care provider. An IME seeks objective information about the examinee's diagnoses, functional abilities and impairments, and other features relevant to addressing medicolegal-related cases by relying on multiple data sources. Best practice guidelines have been established for the completion of physical IMEs. However, similar mental and behavioral disorder (M&BD) standards are less common, and M&BD IMEs often do not follow a consistent process. This article offers guidance on applying and adapting existing standards to M&BD IMEs. We outlined the appropriate use of psychiatric nomenclature and how to apply recent changes to Chapter 14 of the AMA Guides to the Evaluation of Permanent Impairment. The article further offers a mechanism for introducing greater objectivity into an otherwise subjective process by employing relevant psychological validity testing and conducting a coherence analysis in formulating an opinion. In summary, we provide a synopsis of current best practices and offer the examiner a method for aligning M&BD IMEs with equally high standards of excellence.
Abstract
In assessing spinal impairment, it is imperative to distinguish between limb pain or numbness that might be radicular, but with no objective verification, from symptoms that represent, in fact, true radiculopathy, ie, pain, numbness, or weakness that was related to objective radiculopathy. In the sixth edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), this distinction determines what row in the spine tables is used to rate impairment. Failure to discern between nonverifiable radicular complaints and true radiculopathy is a source of frequent errors in spinal impairment rating. True radiculopathy is pain, numbness, and/or weakness from nerve root damage, most commonly from a disc herniation. This article will review how the AMA Guides has dealt with the concept of radiculopathy through the years.
Abstract
Credibility of expert witnesses is essential. It is important that medical experts do not incorrectly assume that administrative law judges are their audience. Instead, it should be noted that most disputes will be resolved between the parties and their representatives. When providing opinions, experts are well-served by understanding the audience as much as practical. The best advice for experts rendering opinions is to remain true to the questions posed and follow the scientific method.
Abstract
Post–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 [COVID-19]) conditions are referred to by a wide range of names, including long COVID, post-acute COVID-19, long-term effects of COVID, post-acute COVID syndrome, chronic COVID, long-haul COVID, late sequelae, and others, as well as the research term, post-acute sequelae of SARS-CoV-2 infection (PASC). Symptoms may include difficulty thinking or concentrating, fatigue, depression, anxiety, and other complaints. The results of studies are clouded by self-reports, lack of objective cognitive data, misattribution, and ill-defined psychological issues. Prospective cohort studies with objective assessment are needed to clarify the impact of COVID-19. While we do not dismiss the presence of long COVID or chronic COVID-19 symptoms lasting beyond a typically expected viral respiratory-transmitted syndrome, neither do we uncritically accept such a syndrome in all those who were diagnosed as having COVID-19, especially in those whose initial presentation was asymptomatic or mild. Evaluators must be astute and perform unbiased, thorough assessments and focus on objective findings while carefully assessing the potential for confounding or alternate conditions.
Abstract
Claims of occupational psychiatric disability have significantly increased over the past 20 years. This article is the third in a series on avoiding psychiatric disability overdiagnosis. The first article focused on general disability issues and their effects and defined basic terms and models. The second article focused on improving the diagnosis and assessment of mental health disorders and psychiatric work disability. In this final article, we focus on iatrogenesis in diagnosing mental health work disability and argue for implementing a comprehensive disability assessment approach.
