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Christopher R. Brigham

QUESTION: Are the multiple impairments added or combined for a patient with multiple peripheral nerve impairments in a lower extremity (LE) injury according to the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (AMA Guides) , Sixth Edition Does it automatically mean that the cited ratings should be added simply because the impairments are listed in the same rating chart May a peripheral nerve impairment be combined with a diagnosis-based impairment ANSWER: Multiple peripheral nerve injuries of the LE are combined

in AMA Guides® Newsletter
James G Underhill
and
Diana Kraemer

on diagnosis-based impairment (DBI). Instead, the chapter used a descriptive approach based on neurologic history and examination. This approach was discordant with the DBI methodology established in the sixth edition of the AMA Guides . Generic Template for Impairment Classification Grid Chapter 1, Conceptual Foundations and Philosophy, organizes the implementation of the AMA Guides principles and provides a template for rating methodology in Table 1-5, Generic Template for Impairment Classification Grids (6th ed, 13). However, several factors from this

in AMA Guides® Newsletter
Christopher R. Brigham
,
Craig Uejo
,
J. Mark Melhorn
, and
James B. Talmage

as an adjustment factor is controversial; however it less likely to be as problematic as some may envision since its use is limited to a non-key adjustment factor. If it is unreliable (the injury or illness history, physical examination, supporting studies, and functional history to not seem to be medically reasonable) then the functional assessment is not used to modify a rating. Additionally, the functional history grade modifier is applied only to the single, highest diagnosis-based impairment (DBI). Standards for the physical examination are provided to

in AMA Guides® Newsletter
Craig Uejo

the entire left arm. Strength testing was recorded as normal in all planes of the elbow and wrist. Opposition and pinch testing in the hands were recorded as normal and equal bilaterally. Vascular examination was normal. Radiographs taken at MMI showed a healed distal radius fracture in anatomic position with no posttraumatic arthritis and no carpal instability. Discussion For most upper extremity injuries there are two methodologies that are considered when using the Sixth Edition: the diagnosis-based impairment (DBI) methodology (primary method) and the

in AMA Guides® Newsletter
James B. Talmage
and
Jay Blaisdell

Shoulder injuries are among the most common reasons for filing a claim within many workers’ compensation systems. Greater familiarity with the methodology found in the AMA Guides, Sixth Edition, Chapter 15, The Upper Extremities, will help physicians avoid common pitfalls associated with rating the shoulder and improve the reliability of impairment ratings. There are significant differences in rating process between the AMA Guides, Fifth Edition, and the AMA Guides, Sixth Edition. Range of Motion or Diagnosis-based Impairment One source of

in AMA Guides® Newsletter