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Christopher R. Brigham

Physicians must account for the effects of multiple impairments with a summary value. The Combined Values Chart (5th ed, 602–604) calculates the combined value of two numbers. Section 1.4, Philosophy and Use of the Combined Values Chart (5th ed, 9–10), explains that a standard formula is needed so the end result does not exceed 100% of the whole person. Using the Combined Values Chart (5th ed, 604–606) and its underlying formula, physicians combine multiple impairments so that the whole person impairment is equal to or less than the sum of all the

in AMA Guides® Newsletter
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Christopher R. Brigham

Physicians may need to account for the effects of multiple impairments with a summary value. The Combined Values Chart (6th ed, 604–606) (5th ed, 602–604) calculates the combined value of two numbers. The Glossary in the Sixth Edition defines the Combined Values Chart as “A method used to combine two or more impairment percentages, derived from the formula A + B(1 − A) = Combined Values of A and B. Combining, as opposed to adding, ensures that the total value will not exceed 100% whole person impairment, and takes into account the impact of impairment from

in AMA Guides® Newsletter
Christopher R. Brigham

Impairment values are more often combined than added. The Combined Values Chart (4th ed., 322-324) calculates the combined value of 2 numbers. The values are derived from the formula A + B(1 − A) = the combined value of A and B, where A and B are the decimal equivalents of the impairment ratings. The premise is that, when calculating the combined value of 2 whole-person impairments, only the impairment of what remains of the person who has already been rendered less than 100% should be computed. This mathematical process prevents an estimate of impairment

in AMA Guides® Newsletter
Christopher R. Brigham

as LE impairments. In “Steps in Determining Impairment” in Section 16.2, Diagnosis-Based Impairment (6th ed, 499), of the AMA Guides , Sixth Edition, item six instructs the following: “Combine lower extremity percentages using the Combined Values Chart in the same extremity as appropriate. If both lower extremities are involved, convert impairments to whole person and combine.” In addition, Section 16.3f, Combining and Converting Impairments (6th ed, 529), states the following: In rare cases of complex injury or occupational exposure, the examiner may

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

, function may be tested with it in place. The visual system should be tested with the patient's glasses or contact lenses in place. 16. Effect of Treatment. (The following excludes the Injury Model for the spine.) An additional small percentage (1% to 3%) may be combined with another impairment percentage by means of the Combined Values Chart if the effects of treatment for an illness prevent adequate impairment measurement. This is true even though the previous state of good health will not be regained, as in hypothyroidism and diabetes (4th ed., 9

in AMA Guides® Newsletter
Mohammed I Ranavaya
and
Robert Rondinelli

Physicians must account for the effects of multiple impairments with a summary value. Sometimes, when dealing with multiple impairments in a single case, there is confusion about whether specific impairments are added or combined, particularly when assessing hand or limb injuries. Combining is accomplished by using the Combined Values Chart presented in the Appendix of each edition. 1 The general rule is that all impairments are combined with few exceptions (see list below). The combining must occur at the same hierarchal level (e.g., upper extremity

in AMA Guides® Newsletter
Lorne K. Direnfeld

not mean accurate diagnosis is unnecessary, but that various conditions can result in similar impairments; two individuals with the same condition may have widely varying manifestations thereof. If a patient has impairments involving several parts of the nervous system (e.g., brain, spinal cord, and peripheral nerves), each should be evaluated separately, and the whole-person impairment estimates combined using the Combined Values Chart (4th ed., 322–324). However, in general, only the condition causing the greatest impairment should be rated. Spinal cord injury

in AMA Guides® Newsletter
Kathryn Mueller

and sensory deficits using the Combined Values Chart on page 322 of the fourth edition . This is the total deficit for the nerve. 5. Combine the total nerve deficit with other appropriate impairments . If the total nerve deficit is a whole body impairment, it must be combined with other whole body impairments. The nerve deficit should be combined with any other impairments in the upper extremity. If there are no other impairments in the upper extremity, convert the extremity impairment to a whole body impairment using Table 3 (4th ed., 20) for the upper

in AMA Guides® Newsletter
Richard T. Katz

% 10% 15% 10% 35% 7% 91% C6 20%/15% 50% 10% 15% 10% 35% 7% 86% C7-8 10%/5% 50% 10% 15% 10% 35% 7% 82% T1-9 0% 35% 10% 15% 10% 5% 7% 60% T10-L1 0% 35% 10% 15% 10% 0% 7% 58% L2-S5 0% 10% 10% 15% 10% 0% 7% 42% The ratings are not simply added, as described in Appendix A (6th ed, 604-606), but rather are “combined” using a formula utilized in many editions of the Guides : Combined Values Formula: A+B(1-A), where A = impairment #1 and B

in AMA Guides® Newsletter
Christopher R. Brigham
and
Randolph Soo Hoo

previous sexual functioning” and the rater is directed to age adjustment criteria outlined in Chapter 7. Neurogenic sexual dysfunction is combined with other related impairments using the Combined Values Chart.

in AMA Guides® Newsletter