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Robert Haralson III

Abstract

In the case of Brown v Campbell County Bd. of Educ., 914 S.W.2d407 (Tenn. 1995), the Tennessee Supreme Court found that use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, was proper and constitutional. Two claimants in this case challenged the constitutionality of Tennessee Statute 50-6-241, which stated, in part, that «the medical impairment rating [is] determined pursuant to the provisions of the American Medical Association Guides.» The Court upheld the constitutionality of the use of the AMA Guides and found that this use did not violate equal protection, in part because the legitimate state interests,—uniformity, fairness, and predictability—are equally applicable to the use of the AMA Guides: «If the Guides were not used, medical opinions would be more subjective, and perhaps arbitrary. It is no surprise, therefore, that most states either mandate, recommend, or frequently use the AMA Guides in Workers' compensation cases.» To date, every appellate court that has dealt with the AMA Guides has upheld its use and/or its constitutionality»; for additional information, see the following cases: Allen v Natrona County School District One, 811 p.2d 1 (Wy. 1991); Duran v Industrial Claim Appeals Office, 883 p.2d 477 (Colo. 1994); and Texas Workers’ Compensation Commission v Garcia, 893 S.W.2d 504 (Tex. 1995).

in AMA Guides® Newsletter
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Robert Haralson
in AMA Guides® Newsletter
Robert H. Haralson III
in AMA Guides® Newsletter
Robert H. Haralson
in AMA Guides® Newsletter
Robert H. Haralson III

Abstract

The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, presents an impairment paradox: Single-level fusions rating using the Diagnosis-related estimates (DRE) method often result in higher impairment values than do multilevel cervical spine fusions. In the AMA Guides, Chapter 15, The Spine, the definition of Cervical Category IV (alteration of motion segment integrity or bilateral or multilevel radiculopathy) changed from the definition in the fourth edition for Cervicothoracic Category IV (loss of motion segment integrity or multilevel neurological compromise) because of changes in the definition of “alteration of motion segment integrity,” which now also includes surgical arthrodesis. This applies only for single-level fusions because the AMA Guides, states the range-of-motion (ROM) method is used in situations when “there is alteration of motion segment integrity (eg, fusions).” The AMA Guides, Fourth Edition, rated impairment on the basis of the injury, not the surgical procedure, and the maximum whole person permanent impairment for a patient with a single-level, single-sided cervical radiculopathy who had a discectomy and fusion would be 15%, but the minimum award for a similar patient rated using the DRE method is 25%. The author reports that, for the reasons outlined, evaluators should rate all cervical fusions, including single-level fusions, using the ROM method.

in AMA Guides® Newsletter
Robert J. Barth
and
Robert Haralson III

Abstract

Complex regional pain syndrome (CRPS) is a controversial, ambiguous, and often unreliable concept that presents significant clinical and rating challenges, to the extent that, for any individual case, many of the differential diagnostic issues provide a far more probable explanation of symptoms than does CRPS. The International Association for the Study of Pain (IASP) introduced CRPS in 1994 specifically to replace “reflex sympathetic dystrophy” [RSD] and “causalgia.” The IASP diagnostic protocol for assessing CRPS has led to overdiagnosis, as well as questions regarding the protocol's reliability, validity, and high error rate during field trials. Using the IASP protocol and the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, the authors discuss the mental health and general medical evaluations that are part of the differential diagnosis of CRPS, which involves both psychological and general medical components. Finally, examiners should be aware that the probability rates for a diagnosis of CRPS following a thorough and extensive differential diagnosis is very small and is further limited by the general lack of scientific credibility for the concept of CRPS. A diagnosis of CRPS in the absence of ruling out all potential differentials is not credible. A sidebar discusses several chapters that are relevant to rating impairment due to causalgia, RSD, and CRPS.

in AMA Guides® Newsletter
Robert H. Haralson III
in AMA Guides® Newsletter
Robert H. Haralson III

Abstract

The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, was published in November 2000 and contains major changes from its predecessor. In the Fourth Edition, all musculoskeletal evaluation and rating was described in a single chapter. In the Fifth Edition, this information has been divided into three separate chapters: Upper Extremity (13), Lower Extremity (14), and Spine (15). This article discusses changes in the spine chapter. The Models for rating spinal impairment now are called Methods. The AMA Guides, Fifth Edition, has reverted to standard terminology for spinal regions in the Diagnosis-related estimates (DRE) Method, and both it and the Range of Motion (ROM) Method now reference cervical, thoracic, and lumbar. Also, the language requiring the use of the DRE, rather than the ROM Method has been strengthened. The biggest change in the DRE Method is that evaluation should include the treatment results. Unfortunately, the Fourth Edition's philosophy regarding when and how to rate impairment using the DRE Model led to a number of problems, including the same rating of all patients with radiculopathy despite some true differences in outcomes. The term differentiator was abandoned and replaced with clinical findings. Significant changes were made in evaluation of patients with spinal cord injuries, and evaluators should become familiar with these and other changes in the Fifth Edition.

in AMA Guides® Newsletter
Robert Haralson III
and
Christopher R. Brigham

Abstract

Because grip and pinch strength are highly correlated and most literature deals with the former, this article focuses on grip strength, which is controversial because, as a functional test, it can be influenced by subjective factors that are difficult to control and include effort, pain, time of day, and fatigue. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) identifies additional factors that influence grip and include sex, age, sensation, comorbidities, age, nutritional status, and, perhaps, handedness. Although grip strength is considered a measure of hand function, its correlation with activities of daily living is poor. Grip strength measurements must be performed in a standard manner because altering wrist, forearm, or elbow position can change the results. Impaired hand strength is compared to that of the opposite extremity, which usually is normal; if both extremities are involved, the strength measurements are compared to the average normal strengths. The AMA Guides specifies that grip measurements are regarded as reliable if there is less than 20% variation in the readings, but subjective factors may result in higher-than-normal variance between measurements of grip. Because pain interferes with maximal effort and, if present, may invalidate grip strength measurement, the latter generally is inappropriate to rate tendonitis or other painful conditions. Generally, grip strength is not used to rate neurological deficits.

in AMA Guides® Newsletter