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Steven D. Feinberg

) substantial medical evidence; (2) causation; and (3) apportionment, all of which directly affect benefit delivery to injured workers. This article discusses the special aspects of addressing and defining substantial medical evidence, causation, and apportionment in the California Workers' Compensation system, and it applies these definitions to examples of cases. In addition, it also includes case scenarios that highlight how evidence-based medicine (EBM), genetics, and age differences could affect these three components (substantial medical evidence, causation, and

in AMA Guides® Newsletter
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Christopher R. Brigham
and
Henry J. Roth

Apportionment analysis is often a critical issue in workers' compensation and tort cases. This reflects the medicolegal interface where case and medical analysis is applied to relevant legal standards. Opinions are expressed to a “reasonable degree of medical probability,” which reflects more than 50% likelihood. The Guides defines this process in Section 1.2, Causation, Apportionment Analysis, and Aggravation (5th ed, 11-12), and in Section 2.5h, Changes in Impairment from Previous Ratings. Apportionment refers to the “distribution or allocation of

in AMA Guides® Newsletter
Stephen L. Demeter
,
Christopher Brigham
,
James B. Talmage
,
J. Mark Melhorn
, and
Steven D. Feinberg

pportionment analysis reflects the medicolegal interface where case (any action) and medical analysis is applied to relevant legal standards. 1 Apportionment is an allocation of causation among multiple factors that caused or significantly contributed to the injury or disease and resulting impairment of function. This article focuses on several examples of orthopedic apportionment and recommendations somewhat unique to these evaluations. For example, a man injured his shoulder 5 years ago while at work; he was diagnosed with a torn rotator cuff and was

in AMA Guides® Newsletter
Stephen L. Demeter
and
E. Randolph Soo Hoo

symptoms (DCO or diffusing capacity for carbon monoxide) until 3 years ago. In a person like this, with a complicated history, a compensable industrial injury, and a confounding prior problem, how is apportionment determined? How are the 3 most recent editions of the AMA Guides used to address this issue? Each edition of the AMA Guides defines apportionment differently. The Fourth Edition defines apportionment as: If apportionment is needed, the analysis must consider the nature of the impairment and its possible relationship to each alleged factor, and it

in AMA Guides® Newsletter
Christopher R. Brigham
and
Aimee McEntire

Impairment apportionment refers to the distribution or allotment of impairment to different factors. 1 These factors include pre-existing injury, illness, or impairment. Apportionment analysis is discussed in Section 1.6b (5th ed, 11-12). “Generally, the most recent permanent impairment is calculated, and then the prior impairment rating is calculated and deducted. The remaining impairment rating would be attributed or apportioned to the current injury or condition” (5th ed, 12). Apportionment decisions are also dependent on how specific state laws

in AMA Guides® Newsletter
Henry J. Roth

presume contribution by a factor with which the impairment is generally or temporally associated. Pitfalls Aging, natural inherent limitations, self-abuse, and psychosocial factors, individually or collectively, confound the occupational medical causality/apportionment assessment. Humans have individual inherent limitations and built-in obsolescence (aging). In addition, some patients never possessed certain physical capabilities regarded as normal. Self-abusive and other behavioral factors may also cause or contribute to impairment. Compensation systems are

in AMA Guides® Newsletter
Phil Walker

process of disability. Two of the most hotly debated new sections of the law are Labor Code Sections 4663 and 4664 on apportionment of disability. The Guides Fifth Edition discusses in Section 1.6b apportionment analysis for impairment; the Guides does not directly evaluate disability. There are aspects of apportionment of disability in California that are clear and not clear. What Is Clear Under new California Labor Code Section 4663 and 4664 the following is clear: Apportionment of permanent disability is based on causation (Cal. L.C. Sec. 4663[a

in AMA Guides® Newsletter
Charles N. Brooks
and
James B. Talmage

Meniscal tears and osteoarthritis (osteoarthrosis, degenerative arthritis, or degenerative joint disease) are 2 of the most common conditions involving the knee. They often coexist in the same (medial or less commonly lateral) compartment(s) of the joint. This article includes definitions of apportionment and causes; presents a case report of initial and recurrent tears of the medial meniscus plus osteoarthritis (OA) in the medial compartment of the knee; and addresses questions regarding how much impairment was due to an initial occupational injury

in AMA Guides® Newsletter
Christopher R. Brigham
and
Leon H. Ensalada

recurrent radiculopathy occurs. Thus, with the Fourth Edition, a patient with multiple injuries with recurrent lumbar radioculpathies (either at the same or a different level) would continue to have the same spinal impairment rating of 10% whole person permanent impairment, based on a DRE Lumbosacral Category III classification. While, this may not seem fair, the philosophy of the Fourth Edition is that radiculopathy can be assigned to a person only once. This exemplifies the difference between impairment and disability. Apportionment The rating of a recurrent

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

Apportionment estimates the degree to which each of various occupational or nonoccupational factors may have caused or contributed to a particular impairment (4th ed., 315). Apportioning spinal impairment among different injuries is often challenging. The Guides does not provide specific instructions on spinal impairment apportionment. Thus, the evaluator must be familiar with both causation analysis and terminology, as well as with spinal impairment evaluation. The Guides defines an aggravation as a physical, chemical, or biologic factor … [that

in AMA Guides® Newsletter