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Christopher R. Brigham
and
Randy Soo Hoo

Abstract

Impairment assessment of male sexual dysfunction using both the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth and Sixth Editions, must be done with appropriate evaluation and objective findings in order to support ratable sexual dysfunction. The fifth edition specified that the absence of sexual functioning results in a maximum rating of 20% whole person impairment (WPI); in the sixth edition, the maximum is 15%. In the AMA Guides, Fifth and Sixth Editions, sexual dysfunction is discussed in Chapter 7, The Urinary and Reproductive Systems, and in Chapter 13, The Central and Peripheral Nervous System. In the fifth edition, Section 7.7, Male Reproductive Organs, provides guidance for impairment percentages for male reproductive organs for men aged 40–65 years; age adjustment is made for males younger than 40 (WPI is increased 50%) and older than 65 (WPI is decreased 50%). Section 13.7d, Sexual System Neurologic Impairments, in the fifth edition of the AMA Guides directs evaluators to use Table 13-21, Criteria for Rating Neurologic Sexual Impairments. In the sixth edition, Section 7.7 similarly offers guidance for impairment percentages for male reproductive organs for men aged 40–65 years but, unlike the fifth edition, allows a 10% upward or downward adjustment at the evaluator's discretion based on the individual's age and level of premorbid sexual functioning. In the sixth edition, Table 7-6, Criteria for Rating Permanent Impairment Due to Penile Disease, presents four classes and three grades.

in AMA Guides® Newsletter
Christopher R. Brigham
,
Charles N. Brooks
,
Stephen Demeter
,
Lorne Direnfeld
, and
Randy Soo Hoo

Abstract

In order to answer questions posed by their clients, evaluating physicians must understand the context of a case or jurisdiction, in part because medical and legal perspectives may differ when an evaluator assesses issues such as causation and apportionment. A condition is not necessarily a ratable impairment, nor do symptomatic conditions necessarily prevent an individual from working. Attorneys may pose very specific apportionment questions based on laws unique to a given jurisdiction; for example, a patient may have an occupational injury or illness that results in impairment, but causation of the impairment may be multifactorial and may involve, for example, age-related degeneration, a pre-existing injury or illness, an occupational injury or illness, and/or subsequent trauma or disease. In some states, the presence of a pre-existing condition when an employee is injured may involve Second Injury Funds that were created to relieve a portion of the employer's/insurer's claim costs when the employer hired or retained an employee with a pre-existing medical condition who then suffered a “second” injury. The latter situation requires more extensive treatment and/or a greater disability due to the combined effects of both conditions. Apportionment of causation and impairment may be complex, requiring evaluation of nonoccupational and occupational risk factors and the natural history of the underlying condition.

in AMA Guides® Newsletter