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Introduction Physicians face many challenges when providing impairment ratings for patients with chronic pain. This article describes how pain is defined in the sixth edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) and raises questions about how to assess a patient's subjective complaints about pain. Impairment Rating and Assessing Function with Chronic Pain Evaluating physicians often face the conundrum of providing an impairment rating and assessing function for patients with a common condition: chronic pain
what can be done to improve the clinical assessment of mental health work disability. Medical impairment (congenital or acquired by illness, injury, or aging) may produce disability. Globally, disability influences our well-being. These are important issues for individuals and for public health policy and government regulations. Health and illness affect how we live our lives, how successfully we can achieve our goals, and whether we will fulfill our duties and responsibilities. 3 , 4 Understanding the Scope of Impairment and Disability The terminology of
EDITORIAL COMMENT Although this article's focus is on COVID-19 and MMI, it is also imperative to assess causation. For guidance on causation and COVID-19, refer to the July/Aug 2020 issue of the AMA Guides Newsletter. Introduction Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was declared a pandemic in 2020 and continues into 2021, and it has affected the work performed in assessing permanent impairment. The SARS-CoV-2 virus is similar in its RNA genetic sequences and
Introduction Historically, the 13 annual issues of JAMA that had been published on impairment ratings from 1958 to 1970 were compiled into a 1971 book. Each issue of JAMA was titled a “guide” to impairment rating of a different body system, so the collective “guides” were published as a single book but called by the plural title, AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) . When a revision was published in 1984 as the second edition, the original 1971 book became known as the first edition. In the original first edition of the
The approach to assessing impairment for headaches differs among the Fourth, Fifth, and Sixth Editions of the Guides. In the Fourth Edition, headache impairment is considered in Chapter 15, Pain, Section 15.9 Headache (4th ed, 311-312). This section discusses the pathogenesis and clinical features of various types of headaches and refers the examiner to Section 15.8, Estimating Impairment (4th ed, 309-311) for the procedure associated with assessing impairment. Figure 2, Pain Intensity-frequency Grid (4th ed, 310) classifies pain according to intensity
In a 1999 study of adults older than age 18, the US Census Bureau and the Centers for Disease Control and Prevention (CDC) cited hearing loss as the fifth most common disability in the US population. 1 Almost 50% of workers in the fields of carpentry, plumbing, and mining have hearing impairment. 2 Hearing impairment rating determination, described in the Guides Fifth Edition, Section 11.2a Criteria for Rating Impairment Due to Hearing Loss (5th ed, 246-351), remains quite simple. A hearing impairment evaluation is derived from a pure-tone audiogram
Introduction Physicians performing evaluations of patients with possible central nervous system (CNS) impairment may need to evaluate the mental status and integrative functions of these patients. CNS impairment may result from a traumatic brain injury (TBI), cerebrovascular disease, post-coronavirus disease (COVID) syndrome, and other illnesses. A full neuropsychological evaluation may not have been performed; therefore, evaluators need cognitive screeners to determine whether it is probable that some deficits require further evaluation. The AMA Guides
Sleep impairment assessment can be challenging since some physicians are unclear about when and how sleep dysfunction should be rated. In reality, sleep impairment should be an uncommon rating since the Guides provide specific requirements in terms of what is ratable and requires documentation by an abnormal sleep study. Although the patient may have complaints of daytime drowsiness associated with a painful musculoskeletal disorder, these complaints are an activity of daily living (ADL) and do not result in a separate sleep impairment rating. This
the injury claim opposed to courts. What does workers' compensation cover? Workers' compensation pays for necessary medical care after work-related injuries or illnesses, temporary disability benefits, permanent partial and total disability for any permanent impairment from the injury, and vocational rehabilitation. It also pays benefits to survivors of workers who die because of work-related causes ( Table 1 ). Workers qualify for compensation if the following three conditions are met: an injury or illness occurred, it arose “out of, or in the course of
through the pelvic ring. Consequently, traumatic pelvic fractures that result from a high-impact event often coincide with damaged organs, significant bleeding, and sensory and motor dysfunction. Treatment for high-impact pelvic fractures usually involves surgery, with the goal of restoring stability so the injured worker can resume activities of daily living. In the AMA Guides to the Evaluation of Permanent Impairment, Chapter 17, The Spine and Pelvis (557–556), Section 17.4, Pelvic Impairment (6th ed, 592–597) the process of rating pelvic fractures is defined
