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. Consequently, there is no valid, reliable way to confirm that tinnitus is present or to evaluate its severity. Impairment and Disability Because there is no way to detect tinnitus or to measure its severity or effects on an individual (which may vary from person to person), there are no scientific data on which to base a judgment regarding impairment or disability. Consequently, tinnitus alone is generally not considered compensable. Until there is some reliable, valid method to substantiate a patient's report, this is probably reasonable. The Guides' practice is
Attributing degenerative disc disease (DDD) to “cumulative trauma” at work is a myth that is not supported by current scientific evidence. The primary cause of DDD is nonoccupational factors (genetics and aging). In fact, various authors have suggested that degenerative disc disease is a misnomer, since it is not a disease, but a normal, inevitable accompaniment of the aging process that occurs at variable rates in different persons. Disc degeneration has been suggested as a semantically more correct name for this development, but degenerative disc
Editor's Comment In this article, we provide physicians and other stakeholders with insights on how causation is assessed in the workers' compensation arena. Although courts often base decisions on expert opinions and precedents, causation analysis should be based on a science. Science provides new understandings that may refute historical precedents. Robert J. Barth, PhD, presented the scientific approach to determining injury relatedness, work relatedness, and claims relatedness in the May/June 2012 issue of the AMA Guides Newsletter. That article
discovery pipeline. 61 , 62 However, the use of AI in scientific writing is controversial. Although AI can facilitate writing and be a powerful tool, it presents challenges regarding the accuracy of information and references provided, including AI hallucinations. 63 - 66 Finally, interventions through AI in health care can also lead to improved health outcomes in lower middle-income class countries. 67 , 68 Although AI can improve health care by making medicine more predictive and preventive, accelerating “the drug-discovery process” and avoiding “late-stage failure
impairment. Given the scientific knowledge base regarding prescription narcotics for chronic benign pain, it is difficult to imagine how any patient could credibly be considered to have reached maximum medical improvement (MMI) if that patient has a narcotic prescription in place. This predicament creates an obstacle to credibly concluding that a presentation of impairment is permanent and, consequently, is also an impediment to completing an impairment evaluation. During the creation of this article, members of the Guides Newsletter Editorial Advisory Board expressed
chronic nonmalignant pain presentations, evaluators should be cognizant of the primacy of psychological factors in the development of claims of permanent impairment from pain, of the association between mental illness and pain complaints, and of the lack of correlation between tissue damage/nociception and pain complaints. Because of such considerations, an impairment evaluator will always be well advised to perform a thorough, competent, and scientifically credible mental health consultation in such cases. Any potential association between mental illness and the pain
discusses the scientific probabilities that are associated with the various differentials. The implication of this discussion is: for any individual case, many of the differential diagnostic issues are going to provide a far more probable explanation (more probable than CRPS). II. The Need to Avoid the Antiquated Concept of “RSD” The concept of “complex regional pain syndrome” was created in 1994 specifically for the purpose of replacing “reflex sympathetic dystrophy [RSD]” and “causal-gia.” 16 Professional literature has clarified that this change was
support such a causative relationship. The concept that favoring one upper limb can result in injury to or illness in the other is not based on scientific evidence; instead, it is an unsupportable myth. Example—Carpal Tunnel Syndrome Many laypersons and physicians believe that repetitious use of an extremity will cause illness or injury. While true in some cases, it is often a misconception. Such findings have relevance for the issue of symptoms developing in an extremity that is opposite to an initially claimed malady. Given the scientific findings that
, scientific methodology and maximal translation thresholds. Detailed evaluation of the medical literature reveals definitions of loss of motion segment integrity that differ from those in the Guides , Fourth and Fifth Edition. Evaluators should also note that the descriptions of the Figures provided in Section 15.1b, Description of Clinical Studies (5th ed, 378–379) were revised in the Errata to the Fifth Edition of the Guides . 1 Ambiguous terminology of the normal maximal translation in the spine (in White, Panjabi 1990 ) has apparently led to subsequent
a historical artifact that is gradually being eliminated by neuroscience research. Evaluators should avoid being misled by the occasional incidental use of older terminology, e.g., organic condition (5th ed, 585), within the Guides . Examples of the overlap between psychological and physiological conditions can be offered both in terms of mental illnesses which are clearly of a physiological-organic nature, and in terms of general medical conditions for which psychological factors have been scientifically established. Examples of Mental Illnesses That
