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on objective findings at maximal medical improvement (MMI). The time to achieve MMI is dependent on several factors including the type of procedure performed and other comorbidities. In the AMA Guides , Section 6.1b, Description of Clinical Studies, explains “Objective procedures useful in establishing impairment by hernias include, but are not limited to: (1) abdominal wall physical examination and (2) imaging by roentgenography or CT scan with or without contrast media.” (5th ed, 119; 6th ed, 103). If a patient has had an appropriate repair than the defect
and Signs (5th ed, 26-28), discusses exercise testing and measuring exercise capacity using the unit of “METS.” One MET is the amount of energy an individual uses while at rest. (One MET is the consumption of 3.5 ml of oxygen per kg of body weight per minute.) Exercise, which requires more energy than being at rest, is measured in multiples of one's resting energy consumption. Section 3.3, Coronary Heart Disease (5th ed, 35-41), is used to rate ischemic heart disease. Maximal medical improvement (MMI) is discussed as follows: Exercise training programs
consulted, who recommended total knee replacement (TKR). However, the patient was apprehensive about this “significant” surgery and elected to retire, hoping that diminished weight bearing would improve her symptoms, with the option to proceed with a TKR if her symptoms worsened. At maximal medical improvement (MMI), the claimant reported moderate left knee pain at rest, increasing to severe pain with prolonged standing and walking. Kneeling or squatting also increased the pain and caused an accompanying feeling of instability in left knee. Physical examination revealed
III would be selected and the individual would receive a rating of 10% whole-person. The final impairment percentage for injuries comes from the Injury Model. The Injury Model is philosophically different from other approaches in the Guides. For most other conditions, when the individual reaches Maximal Medical Improvement (MMI), the degree of anatomic and/or physiologic loss that persists is rated. In contrast, the Injury Model rates the severity of the original injury, not the degree of recovery. The philosophy is that it is difficult to quantify spinal loss
the diagnosis or diagnoses, provide appropriate objective findings that verify an upper digestive tract disease, determine the etiology of that disease, assess maximal medical improvement (MMI), and apply correctly the criteria in the Guides . Gastroesophageal reflux disease (GERD) is a condition in which acid and enzymes from the stomach flow up into the esophagus. Reflux occurs if the distal sphincter in the esophagus or other protective mechanisms fail. It is a common condition; one out of five people experience heartburn or acid regurgitation on a weekly
Edition does recognize that surgery may increase the risk of anatomical changes in the future, including transitional disease above the level of a fusion; however, ratings are performed when the individual's condition is considered stationary (ie, at maximal medical improvement [MMI]) without consideration of possible future changes in that condition. Examples 17-3 and 17-4 in the Guides are helpful clinical vignettes that illustrate the difference between the Sixth and Fifth Editions in this regard. Example 17-4 was treated non-surgically for a single level cervical
(anatomical, physiological, or other) from the “normal” person or the individual's preincident function? Has the individual attained maximal medical improvement (MMI)? How difficult is it to maintain an individual at MMI, and what is needed to maintain those levels? What are the interferences in an individual's activities of daily living (ADLs) created by the impairing condition? For an individual who has undergone a cardiac transplantation, the general issues that could be assessed as causing impairment are: The resulting physiological function of the
bias. Potential Gender Bias due to Common Gender Differences The purpose of the AMA Guides rating is to assess medical impairment changes in organ system anatomy and function at maximal medical improvement (MMI) and to identify the impact of the impairment on the individual's function, based on the ability to perform activities of daily living (ADLs). The impact on ADLs can provide direct and indirect examples of work ability; however, the Fifth Edition specifically notes that impairment reflects decreases in an “individual's ability to perform common ADLs
may influence when a physician defines the patient at maximal medical improvement (MMI). A treating physician may want to inflate a rating, particularly if the impairment number does not appear to reflect a level of perceived disability. A physician alternatively might want to portray a positive outcome from therapeutic interventions, and thus would underrate findings, particularly those that are difficult to quantify such as neurological findings. Therefore, being totally “independent and unbiased” may be a challenge. From a practical perspective, many
) A question could be raised whether the patient was at maximal medical improvement (MMI) since the examining physician suggests an open carpal tunnel release with partial excision of the transverse carpal ligament. However the examinee has chosen not to pursue medical care. Section 2.5g Adjustments for Effects of Treatment and Lack of Treatment (5th ed, 20) states that: A patient may decline surgical, pharmacologic, or therapeutic treatment of an impairment. If a patient declines therapy for a permanent impairment, that decision neither decreases nor increases
