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

Abstract

The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Third Edition, exclusively used the Range of Motion (ROM) Model to rate motion of the spine. The fourth edition requires the additional use of an inclinometer and also indicates that the Injury Model is the primary method for evaluating the spine; the ROM Model can be used as the differentiator or tie breaker. The ROM and the Injury Models cannot be used interchangeably, and the final rating always should be based on the Injury Model, not the ROM Model. One of the goals of changing the evaluation method is to create a more reproducible rating system. Because the Injury Model uses only objective findings present at the time of examination or found in the record, it is more reproducible. A further difference between the Injury and ROM Models is that in the former the examining physician rates the results of the injury, not the results of the treatment. The AMA Guides also requires that the patient's condition be stable—ie, not likely to change for one year. In the spine, the results of the injury, not the treatment, are rated, and often this can be done within several days of the injury.

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

Abstract

According to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) the impairment rating of patients with Carpal Tunnel Syndrome (CTS) begins with a documented, objectively verifiable diagnosis by nerve conduction testing and is not based on symptoms only. A motor latency of more than 4.0 msec or a sensory latency of more than 3.7 msec clearly defines CTS, but the relative slowing of the median nerve should not be the basis of a CTS diagnosis for an impairment rating. After correct diagnosis, the next consideration is rating the impairment of patients with CTS who have not had surgery. The AMA Guides provides tables that summarize the calculations of common impairments and typically involve the maximal value of the median nerve's loss of function times a severity multiplier. Examples show the calculations for examples of impairment, including complete transection of the median nerve at the wrist, with and without severe reflex dystrophy (causalgia); a patient with CTS who has decreased two-point recognition (7-15 mm) but normal motor function, with and without normal sensation on two-point testing and no motor weakness. The article also discusses the questions that should be answered to determine if a patient who has had surgery for CTS has a permanent disability.

in AMA Guides® Newsletter
James B. Talmage

Abstract

Sun-related skin disorders are rated, along with all dermatological disorders, using Chapter 8, The Skin, in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) and are based on three factors: the presence of a skin disorder (signs and symptoms); need for treatment; and interference with activities of daily living (ADL). This Case Presentation illustrates some of the challenges that an evaluator new to the rating process may encounter and clarifies that precautionary guidance to reduce sun exposure is not equivalent to interference in ADL and the assignment of impairment. The patient has been a firefighter since 1986, previously worked in construction, lives in Southern California, and surfed recreationally until six or seven years ago. He presents with new lesions of his skin following sun exposure and has been followed by his primary care physician and his dermatologist regarding his basal cell carcinoma and cryosurgeries to treat actinic keratoses. The evaluator determines class 3, 25% impairment, which precludes ADL in the midday sun. The authors note two immediate red flags: Misnaming the AMA Guides is a typical beginner's error, and the evaluation provides no reference to specific criteria or tables even though the State of California uses the fifth edition to rate workers’ compensation cases.

in AMA Guides® Newsletter
James B. Talmage

Abstract

Part 1 of this series examined many of the rules in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, regarding rating nerve entrapment or focal neuropathies; the current article, part 2, examines how to read and match the findings in an electrodiagnostic report to the criteria in Appendix 15-B, Electrodiagnostic Evaluation of Entrapment, as explained in Section 15.4f, and determine the severity of the test findings as listed in Table 15-23. Physicians who perform nerve conduction studies often use their own definitions of mild, moderate, and severe; these definitions are not standardized and frequently differ from the electrophysiologic definitions used in the AMA Guides, Sixth Edition. When examiners rate focal entrapment neuropathy, they must match data from the electrodiagnostic report to the criteria in Appendix 15-B, and a figure shows a hypothetical motor nerve conduction report for a case that shows both mild neuropathy (conduction delay) of the median nerve at the wrist (carpal tunnel syndrome) and severe neuropathy (axon loss) of the ulnar nerve at the elbow (cubital tunnel syndrome). If both fibrillations and positive waves are seen in the same muscle, the reviewer can be more confident that other electromyographic potentials were not misinterpreted as fibrillations. Prepared with the results of electrodiagnostic studies, the evaluator can work through the steps of history, physical findings, and functional scale to determine the final upper limb impairment according to the AMA Guides.

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