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James B. Talmage
in AMA Guides® Newsletter
James B. Talmage

Abstract

This article continues the discussion from the previous issue regarding common impairment rating scenarios for individuals who have had back surgery: Scenario 6) What is the impairment rating for an individual who has had a spinal fusion operation? 7) What is the impairment rating for an individual who has pre-existing spondylolisthesis, has a back strain injury, and undergoes a spinal fusion operation? 8) What is the impairment rating of an individual with spinal fracture(s) who has been treated by spinal fusion? 9) What about surgical complications? The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) notes that, following the Injury Model, surgery to treat an impairment does not modify the original impairment estimate. Major postoperative complications such as myocardial infarction and deep venous thrombosis are covered by most workers’ compensation systems; thus they should be rated, and the rating should be combined with the rating for the injury. The article discusses ratings for arachnoiditis; discitis; bowel, bladder, and sexual impairment; pseudarthrosis following attempted fusion; and chronic pain syndrome (note that it is never appropriate to rate an individual for both a spinal injury and chronic pain syndrome). The AMA Guides recognizes that rating spinal impairment is challenging and may change over time.

in AMA Guides® Newsletter
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James B. Talmage

Abstract

The authors respond to the two-part article by Ensalada in the November/December 1997 and January/February 1998 issues of The Guides Newsletter. Disability determination in the AMA Guides to the Evaluation of Permanent Impairment often is based on formulations that use a scaled ranking of the impaired function(s) that approximates the impact on the individual's ability to perform specific tasks. The method, although imperfect, generates a percentage impairment score for rating the disability. This method breaks down when applied to disorders with far-reaching effects, such as reflex sympathetic dystrophy (RSD), because it tends to focus only on the affected extremity. The AMA Guides also identifies five factors can affect disability in individuals with RSD: First, RSD spreads in an unpredictable temporal manner. Second, RSD is associated with global effects on cognitive processes (eg, constant pain leads to impairment of sleep, decreased alertness, and altered attention). Third, depression often is a reactive consequence to impaired function. Fourth, RSD may change over time yet may remain quite disabling. Fifth, RSD can significantly affect remote systems (eg, bladder disturbance). For these reasons, during the evaluation of people affected by RSD, physicians should be aware of additional issues besides the percentage loss of function of the affected injured extremity.

in AMA Guides® Newsletter
James B. Talmage

Abstract

Coronary artery disease is quite common, and physicians often are asked about the work capacity of patients with coronary disease; less commonly are physicians asked to rate the patient's permanent impairment. In such cases, Chapter 6, Cardiovascular System, of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) is used to rate impairment. The AMA Guides directs the physician who is rating impairment to place the individual in one of four classes of impairment. Class 1 impairment is rarely used because patients often have neither significant lesions nor a history of angina. The likelihood of disease progression may qualify these individuals as impaired even in the absence of symptoms. Patients with Class 2 impairment have no symptoms even with moderately heavy activity, and moderate dietary adjustment or medication is required to prevent symptoms. Class 3 impairment describes individuals who have symptoms of congestive heart failure or angina with moderately heavy activity. According to the AMA Guides criteria, patients in Class 3 would qualify for US Social Security benefits. Class 4 impairment describes individuals who have symptoms during ordinary activity and should have signs or laboratory evidence of cardiac enlargement and abnormal ventricular function. For each class, the AMA Guides describes a range of impairment ratings and provides examples.

in AMA Guides® Newsletter
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James B. Talmage

Abstract

Functional capacity testing typically involves musculoskeletal evaluations using instruments such as inclinometers, goniometers, range-of-motion machines, and strength analyzers. Depending on the organ system to be tested, a variety of tests are available to assess physiological competency (eg, liver function or renal function tests). The cardiopulmonary exercise test (CP Ex test) is one test that defines work capacity and addresses the two primary issues necessary for muscle movement: the adequacy of the cardiac output and that of the lungs to acquire oxygen and excrete carbon dioxide. A normal test requires correct functioning in five organ systems: the heart, the lungs, the hematopoietic system, the vascular system, and the muscles. The CP Ex test can discriminate between individuals with poor exercise capacity caused by hyperventilation, obesity, or malingering. The CP Ex test is not required when one is rating impairments according the AMA Guides to the Evaluation of Permanent Impairment, but the test may help physicians understand the basis for decreased exercise tolerance, thereby facilitating the impairment rating process. Finally, the CP Ex text is useful for assessing functional capacity but does not address all the physiologic, anatomic, and functional issues—no single test can do so—but the CP Ex test provides a very adequate way to address an individual's functional capacity.

in AMA Guides® Newsletter
Restricted access
James B. Talmage
in AMA Guides® Newsletter
Restricted access
James B. Talmage
in AMA Guides® Newsletter
James B. Talmage
in AMA Guides® Newsletter
Restricted access
James B. Talmage
in AMA Guides® Newsletter
Restricted access
James B. Talmage
in AMA Guides® Newsletter