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Christopher R. Brigham
,
Stephen L. Demeter
, and
E. Ranolph Soo Hoo

Introduction Determining the factors contributing to the disease in evaluating pulmonary disease is critically important. In the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment ( AMA Guides) , Sixth Edition, Section 5.3, Environmental Exposures, Lifestyle Choices, and Pulmonary Disease (6th ed, 80), emphasizes the importance of obtaining a thorough history of tobacco use and occupational exposures. This history is mandatory in assessing impairment related to cardiopulmonary issues. It should be noted in all evaluations

in AMA Guides® Newsletter
Mohammed I. Ranavaya

determinable. The argument follows then that there can be no permanent impairment from an MCS diagnosis because neither the pathophysiologic basis of the MCS in any individual nor a causal relationship of a variety of subjective complaints involving multiple organ systems to alleged environmental exposure can be established by objective medical means. It should be noted, however, that an individual given an MCS diagnosis may also be experiencing some other medically determinable condition. Evaluation should be directed to ruling out other diagnoses. This is usually

in AMA Guides® Newsletter
Joel Weddington
,
Charles N. Brooks
,
Mark Melhorn
, and
Christopher R. Brigham

to support the diagnosis? Epidemiological data: What is the epidemiological evidence for the disease or condition? Does quality data support a relationship with work? To what extent is the condition idiopathic? Evidence of exposure: What evidence, predominately objective, is there that the level of occupational and environmental exposure could cause the disease? Other relevant factors: What other relevant factors are present in this case? Are there individual risk factors other than the occupational and environmental exposure that could contribute to the

in AMA Guides® Newsletter
Frederick Fung

outcomes of environmental exposures. It is important to distinguish medical specialty boards recognized by the American Board of Medical Specialties ( www.abms.org ) from unrecognized boards. It is also important to evaluate the qualifications of “experts” involved in specific cases to assure that assessments are accurate and unbiased. Toxicology is a medical science that emphasizes precision and accuracy. In order to avoid confusion in the practice of toxicology, appropriate terminology is essential. For example, agents refer to chemical (benzene, lead), biological

in AMA Guides® Newsletter
Garson M. Caruso
,
Les Kertay
, and
Christopher R. Brigham

syndromic illnesses, ie, consisting of and defined by symptoms, and remain controversial within the scientific community. 107 For example, there is at present no clear unifying or generally accepted physiologic or behavioral health basis for these conditions, with theories including genetic influences, prior or ongoing environmental exposures (especially infection), endocrine and metabolic derangements, behavioral health disorders such as depressed mood and sleep disturbance, effects of physical or emotional stress, and changes in the body's immune system or energy

in AMA Guides® Newsletter