...Christopher R. Brigham, MD; Charles N. Brooks, MD; James B. Talmage, MD Impairment evaluations not performed following processes defined in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) usually result in erroneous ratings. Common lower extremity impairment rating (IR) errors...

... multiple combined impairments of a lower extremity result in impairment greater than amputation of the entire lower extremity? In the Sixth Edition, Table 2-1, Fundamental Principles of the Guides states “No impairment arising from a member or organ of the body may exceed the amputation value...

...Christopher R. Brigham, MD Chapter 17, The Lower Extremities, in the AMA Guides to the Evaluation of Permanent Impairment ( AMA Guides ), Fifth Edition, continues to provide three means of assessing impairment: anatomic, diagnostic, and functional. Changes from the AMA Guides, Fourth Edition...

...William S. Shaw, MD; Charles N. Brooks, MD © 1999 American Medical Association. All Rights Reserved. 1999 American Medical Association The approach to evaluation of lower extremity impairments in the Guides 4th edition differs from previous editions. Using case studies, this article...

...William S. Shaw, MD; Charles N. Brooks, MD The process of assessing lower extremity impairment described in the AMA Guides to the Evaluation of Permanent Impairment ( AMA Guides ), Fourth Edition, differs from that in previous editions. This article addresses common questions that arise in knee...

... the conditions that should be considered when evaluating a lower extremity. Examinee: Date: Evaluation of the lower extremity reveals findings which might warrant impairment ratings in the following categories. Final impairment is calculated based on clinical diagnosis, and in a manner...

... adopted use of the AMA Guides, Fourth Edition, in 1997. © 1998 American Medical Association. All Rights Reserved. 1998 American Medical Association Anatomical, diagnostic, and functional methods are used in evaluating permanent impairment of the lower extremity. Section 3.2 advises...

...William S. Shaw, MD The AMA Guides to the Evaluation of Permanent Impairment ( AMA Guides ), Fourth Edition, introduces a new system of rating lower extremity impairments that allows use of more than one method for arriving at a rating. Such flexibility allows the rater greater leeway to assess...

... Impairment Training Workbooks are designed to review and reinforce the concepts described in the Sixth Edition. The following questions and answers, excerpted from the Guides Sixth Impairment Training Workbooks - Lower Extremities , 1 illustrate some of the principles of assessment common...

... and inconsistencies within the Guides' Fifth Edition. In March 2002, the AMA published a 16-page errata (available from AMA Press or online at www.ama-assn.org/catalog/guideserrata.pdf ). The errata, however, has only one correction for Chapter 17, The Lower Extremities, a correction to tables cited in example 17...

...James B. Talmage, MD; Jay Blaisdell, MA; Christopher R. Brigham, MD Nerve lesions caused by traumatic events to the lower extremity's peripheral nerves are rated using Section 16.4 of the sixth edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). Results from sensory...

...Christopher R. Brigham, MD The AMA Guides to the Evaluation of Permanent Impairment ( AMA Guides ), Sixth Edition, takes approaches to the lower extremities that are consistent with Chapter 15, Upper Extremities (reviewed in the March/April 2008 issue of The Guides Newsletter ). Because...

..., permanent impairment. Procedures for rating extremity neural deficits are described in Chapter 3, The Musculoskeletal System, section 3.1k for the upper extremity and sections 3.2k and 3.2l for the lower limb. Chapter 4, The Nervous System, section 4.4, provides additional information, including one...

... of the State of Colorado and stratified into three broad categories: 40 upper extremity cases, 60 lower extremity cases, and 150 whole person cases. Only case records with adequate documented evidence to enable rating among all three editions of the AMA Guides were included. The average age of the examinee...

... impairment to the peripheral or brachial plexus nerves are rated using Section 15.4e, Peripheral Nerve and Brachial Plexus Impairment, for upper extremities and Section 16.4c, Peripheral Nerve Rating Process, for lower extremities. Verifiable nerve lesions that incite the symptoms of complex regional pain...

... extremity impairment and finally converts the final lower extremity impairment to whole person impairment. Two or more conditions often are found in the knees and require causation analysis in which the physician should choose the single causally related diagnosis that will yield the highest impairment...

... to whole person impairment ratings before combining. In most lower extremity impairment cases only one evaluation method is used, but certain circumstances justify combining impairments. Examples in the lower extremity include diagnosis-based estimates with short leg, degenerative joint disease...

...Christopher R. Brigham, MD The approach to evaluation of lower extremity impairments in the AMA Guides to the Evaluation of Permanent Impairment ( AMA Guides ) differs from that given in previous editions. This article uses case studies to illustrate practical applications of current approaches...

... from a different limb (either from both upper or lower limbs) even though they may be expressed at the same hierarchal limb (eg, upper extremity or lower extremity), they should be combined at the WPI level only after the individual limb is fully rated and the final impairment for that limb...

...Christopher R. Brigham, MD; Charles N. Brooks, MD; James B. Talmage, MD Causation analysis always should be based on current scientific evidence and the facts of a specific case rather than common opinions or beliefs, eg, the myth that “favoring” one lower extremity often results in injury...