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Fabien Gagnon
and
Les Kertay

Introduction Clinicians and researchers have noted an increase in claims of occupational psychiatric disability over the past 20 years. This article is the first of a three-part series on how to avoid psychiatric disability overdiagnosis. The first article is about general disability issues and their impact on individual well-being, social participation, and frequently associated poverty. The second article will focus on ways to improve the diagnosis and assessment of mental health work disability. The third article will discuss iatrogenesis in diagnosing

in AMA Guides® Newsletter
Steven D. Feinberg
,
Christopher R. Brigham
, and
Charles N. Brooks

. Frequently a patient's perception and presentation suggest significant disability, yet there are no or insufficient objective findings on physical examination and diagnostic tests to corroborate the patient's subjective complaints. 1 Individual reaction to physical illness and injury is markedly influenced by educational, cultural, social (including litigation), and psychological factors, as well as life experiences and beliefs. 2 Given its inherently subjective nature, pain is difficult to validate. Questions are often asked whether a patient's behavior reflects

in AMA Guides® Newsletter
Joseph A. Hirsch
,
Steven Mandel
,
Kurt T. Hegmann
,
Alexandra G. Stratyner
,
Stuart Gitlow
,
James B. Talmage
, and
Christopher R. Brigham

brain is controversial, with some arguing in favor of that position, while others argue that this model is incomplete or oversimplified, especially regarding the neurotransmitter dopamine (DA) hypothesis. 4 - 8 This distinction may be important in determining whether drug addiction is a disability in a selected subpopulation of abusers. Are users able to adjust their behavior and discontinue abusing substances? Or is their substance abuse determined by genetic factors? Or are both factors at play? 9 With this in mind, a multidisciplinary task force of clinicians

in AMA Guides® Newsletter
Gordon Waddell
,
A. Kim Burton
, and
Mansel Aylward

Editorial Comment This invitational article provides a superb framework for understanding the critical distinctions between impairment and disability, the essential aspects of the disabling process, and the need to understand the experience of sickness and disability from a biopsychosocial perspective. Impairment and disability are not synonymous; therefore, impairment does not directly correlate with disability or work loss. Our common goal should be mitigating factors that result in impairment and disability, permitting individuals to be exceptional

in AMA Guides® Newsletter
Glenn Pransky
,
Radoslaw Wasiak
, and
Jay Himmelstein

Physicians performing impairment and disability evaluations will interact with a variety of benefit systems. The evaluating physician should understand the structure of these systems and the types of medical information they require. In this article we review one of the largest disability systems, Social Security Disability Insurance (SSDI). Although this system does not make use of the AMA Guides to the Evaluation of Permanent Impairment, it is not uncommon that an examinee being evaluated for permanent impairment will also be receiving SSDI benefits

in AMA Guides® Newsletter
Robert L. Knobler
,
Charles N. Brooks
,
Leon H. Ensalada
,
James B. Talmage
, and
Christopher R. Brigham

To the Editor We read with interest the two-part article on “The Challenge of Evaluating RSD Impairment and Disability” by Leon H. Ensalada, MD, that appeared in the November/December 1997 and the January/February 1998 issues of The Guides Newsletter. Disability determination is often based on formulations that use a scaled ranking of the impaired function(s) that approximates the impact on the individual's ability to perform specific tasks. The methoq, although imperfect, generates a percentage impairment score for rating the disability. However, this

in AMA Guides® Newsletter
E. Randolph Soo Hoo

Social Security Disability Overview President Franklin Roosevelt signed the Social Security Act into law on August 14, 1935. The original act did not include coverage for disability benefits until it was amended by Congress under Title II of the act and signed by President Eisenhower in 1954. This was called old-age, survivors, and disability insurance. During President Nixon's term, the act was amended under Title XVI to include supplemental security insurance for individuals with limited income and who were disabled, blind, or aged ≥65 years. Disability

in AMA Guides® Newsletter
Marcos Iglesias

Whether you are a health care practitioner, employer, claims professional, or attorney involved in workers' compensation, personal injury, or disability cases, disability is something you deal with on a daily basis. Yet, many of us were not formally trained in the evaluation and management of disability. Over the years we may have become familiar with certain benefit systems such as workers' compensation; however, we may be unfamiliar with other systems and disability from a broader perspective. Thus, it is essential that we understand the language of

in AMA Guides® Newsletter
Christopher R. Brigham

, authors, and our readership. I am especially indebted to James B. Talmage, MD, who has been at my side for the entire journey, and Stephen L. Demeter, MD, MPH; they are both astonishing clinicians, experts, and cherished friends. When we started this newsletter, our understanding of impairment and disability was somewhat murky; however, less so than in 1984 when the American Academy of Disability Evaluating Physicians (AADEP), now known as the International Academy of Independent Medical Examiners (IAIME), started tackling these issues. Through rigorous debate

in AMA Guides® Newsletter
Christopher R. Brigham

The Guides to the Evaluation of Permanent Impairment is the most widely used and accepted reference for evaluating permanent impairment. Unfortunately, many individuals and entities erroneously consider the concepts of impairment and disability as interchangeable when they are not. The Guides defines impairment as the “loss, loss of use, or derangement of any body part, system or function” (4th ed., 315). Disability, on the other hand, “may be defined as an alteration of an individual's capacity to meet personal, social or occupational demands, or

in AMA Guides® Newsletter