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Mohammed I. Ranavaya

Abstract

The diagnostic criteria for asthma usually are straightforward and generally follow the Guidelines of the American Thoracic Society (ATS). The assessment of impairment and disability from asthma is complex because of the variable nature of the disease, and the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) gives physicians discretion to adjust the class of impairment based on the frequency of asthma attacks and the physician's judgment. A physician with expertise in lung disease may use the ATS Guidelines for impairment along with the AMA Guides to determine respiratory and whole person impairment, and a table compares the AMA Guides and the ATS Guidelines in support of assessing whole person impairment. An evaluation protocol addresses the steps in the process (all should be well documented): confirm the presence of asthma; determine its severity; estimate the permanent whole person impairment (a table lists classes of whole person impairment based on the AMA Guides and the ATS Guidelines); and assess work-related asthma. In some cases, an individual with airway hyperresponsiveness may not have an impairment but may have disability for specific jobs. The protocol and suggestions offered here may be practical in most circumstances for evaluating asthma impairment and disability.

in AMA Guides® Newsletter
Mohammed I. Ranavaya

Abstract

Impairment and disability resulting from claims of multiple chemical sensitivity (MCS) challenge independent medical examiners because of polemics associated with the syndrome, and the mainstream medical community has questioned its very existence as a medical disease entity. Since the syndrome was described in 1952, MCS has had many names, including universal allergy, total allergy syndrome, ecologic illness, 20th century disease, and chemical AIDS. Epidemiologic data show that a higher proportion of females (up to 88%) suffer from MCS, and the percentage of unemployment among MCS sufferers may be as high as 85%. The best explanation to date for MCS is that it is an illness belief system manifested by culturally shaped illness behavior. Several distinguished scientific organizations, including the AMA, conclude that there is no scientific evidence to support the MCS concept of a physiologic exposure–disease relationship; the proposed diagnostic tests and treatments have not been shown to have value; and MCS should not be a recognized clinical syndrome. Impairment evaluations should follow the guidelines in Chapters 1 and 2 of the AMA Guides to the Evaluation of Permanent Impairment. Evaluators must recognize that MCS claimants often present with comorbid psychiatric conditions, and iatrogenic disability also is a concern among MCS patients.

in AMA Guides® Newsletter
Mohammed I Ranavaya
and
Robert Rondinelli

Abstract

Physicians must account for the effects of multiple impairments using a summary value. Sometimes, when dealing with multiple impairments in a single case, the evaluating physician may be confused about whether specific impairments are added or combined, particularly during the assessment of hand or limb injuries. Combining is accomplished by using the Combined Values Chart presented in the Appendix of each edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). With a few exceptions, the general rule is that all impairments should be combined. The combining must occur at the same hierarchal level (eg, upper extremity impairment can be combined only with another upper extremity impairment from the same limb), and whole person impairment (WPI) can be combined only with another WPI impairment. In case of impairments 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 is expressed at the WPI level. Evaluators should remember that impairing factors (sensory, motor, vascular, and so on) are combined at the smallest common unit (ie, digit < hand < upper extremity < whole person).

in AMA Guides® Newsletter
Mohammed I. Ranavaya
and
James B. Talmage

Abstract

Although several states use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) when they evaluate individuals with impairments and disabilities, various disability systems exist in the United States. Disability and compensation systems have arisen to ensure that disadvantaged members of society with a medically determinable impairment, which may lead to a disability, have recourse to compensation from various sources, including state and federal workers’ compensation laws, veterans’ benefits, social welfare programs, and legal avenues. Each of these has differing definitions of disability, entitlement, benefits, procedures of claims application, adjudication, and the roles and relative weights assigned to medical vs administrative deliberations. Workers’ compensation statutes were enacted because of inadequacies of recovery from claims for injured workers under common law. Workers’ compensation is a no-fault system adopted to resolve the dilemmas of tort claims by providing automatic coverage to employees injured during the course of employment; in exchange for coverage, employees forego the right to sue the employer except for wanton neglect. Other workers’ compensation programs in the United States include the Federal Employees Compensation Act; the Federal Employers Liability Act (railroads); the Jones Act (Merchant Marine Act); the Longshore and Harbor Workers’ Compensation Act; the Department of Veterans Affairs; Social Security; and private, long-term disability insurance.

in AMA Guides® Newsletter
Mohammed I. Ranavaya
and
Dwight K. Dowda

Abstract

Evaluations of the cervical and the lumbar spine are similar with the major exception that injury in the cervical spine may cause spinal cord damage that results in long-tract signs (weakness, numbness, or paralysis). The AMA Guides to the Evaluation of Permanent Impairment recognizes eight categories of cervical spine injury, and the first five are similar to those used for the lumbar spine. Category I involves no objective findings. Category II includes objective findings such as true muscle spasm, dysmetria, or nonverifiable radicular symptoms. Category III is radiculopathy and is assessed when the patient shows signs such as the loss of relevant reflexes or unilateral atrophy with a greater than 2-cm decrease in circumference compared with the unaffected side. Category IV is loss of motion segment integrity or multilevel neurologic compromise and indicates 3.5 mm or more translation of one vertebra on another on flexion and extension x-rays. Category V is severe upper extremity neurologic compromise that requires the use of upper extremity external functional or adaptive devices. Categories VI, VII, and VIII reflect a significant change in evaluating method and include long-tract signs in addition to upper extremity involvement. Category VI includes cauda equina–like symptoms without bowel or bladder involvement. Category VII is the same as Category VI but with bowel or bladder involvement. Category VIII is paraplegia, defined as complete or near-complete loss of function in the lower extremities.

in AMA Guides® Newsletter
Mohammed I. Ranavaya
and
Christopher R. Brigham

Abstract

Since its inception more than six decades ago, the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), has become internationally accepted as a global benchmark and is used in the United States, Canada, certain European countries, the Middle East, Australia, New Zealand, and Southern Africa, as well as by the United Nations. When the AMA Guides, Sixth Edition, adopted the terminology and conceptual framework of disablement developed by the World Health Organization, this paradigm shift let to an increase in the worldwide influence and use of the AMA Guides. In the United States, the AMA Guides is used primarily in state and federal workers’ compensation systems and sometimes in automobile casualty and personal injury arenas. Most workers’ compensation jurisdictions across Canada use the AMA Guides formally by statute or regulation, or they accept its use informally as a standard tool to rate impairment. In Australia, the AMA Guides is used in both federal and individual state or territory compensation schemes for personal injuries that arise from work, as well as motor vehicle accidents (a table presents uses of the AMA Guides in Australian jurisdictions). New Zealand uses the AMA Guides, Fourth Edition, and the ACC User Handbook to the AMA “Guides to the Evaluation of Permanent Impairment,” Fourth Edition. The AMA Guides is used in Hong Kong to evaluate all types of damages for personal injury claims and also is referenced in Southern Africa, Europe, and countries in the Middle East.

in AMA Guides® Newsletter
Robert D. Rondinelli
,
Marjorie Eskay-Auerbach
,
Mohammed I. Ranavaya
, and
Christopher R. Brigham

Abstract

The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Sixth Edition, is the recognized international standard for assessing impairment. The National Council on Compensation Insurance (NCCI) conducted a comparative study to examine the effects on impairment ratings in three states that have switched from the fifth to the sixth edition. The purpose and objectives of this article are as follows: 1) to provide a brief review of the conceptual framework and terminology of disablement and of the current model of disability in the AMA Guides and also to underscore the importance of the construct of medical impairment to compensation schemes within workers' compensation and other disability systems; 2) to examine the AMA Guides in terms of its origin, purpose, distribution, applications, and misapplications; 3) to examine the changes in the sixth edition in terms of efforts to direct change and improve upon the AMA Guides; 4) to examine the merits and shortcomings of the NCCI study and its conclusions within a broader context of inherent sources of variance in impairment ratings, as well as the content validity, reliability, and reproducibility of the ratings themselves; 5) to provide recommendations regarding the implications of this study for the use of the sixth and earlier editions of the AMA Guides, and to suggest new directions for much needed critical research.

in AMA Guides® Newsletter