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Robert J. Barth
and
Christopher R. Brigham

Introduction “Does head trauma cause a pre-existing benign meningioma to become malignant ” Meningiomas are “slow-growing neoplasms that most likely derive from the meningothelial cells of the arachnoid layer.” 1 This question provides an excellent foundation for exploring the process of causation analysis. The baseless nature of claims of trauma causing cancer had long been highlighted in publications documenting United States (US) Supreme Court rulings from the 1990s regarding expert witness work. A prominent and quotable example is the work of Peter

in AMA Guides® Newsletter
Joseph R. Spiegel
,
Steven Mandel
,
Robert T. Sataloff
, and
Judith Creed

, and regurgitation. Dysphagia caused by mechanical obstruction or muscular weakness primarily affects the swallowing of solids. Disorders of cognition, neuromuscular deficits, and respiratory weakness can affect liquid and solid nutrition. Swallowing disorders may occur following injury to the head, neck, or chest; after toxic ingestion; as a result of numerous diseases (neurological, malignant, and otherwise); or due to aging. The swallowing mechanism can be separated into three stages: oral, pharyngeal, and esophageal. Abnormalities of any stage or of a

in AMA Guides® Newsletter
Christopher R. Brigham
,
Stephen L. Demeter
, and
E. Ranolph Soo Hoo

airways, destruction of the lung's parenchyma (ie, emphysema), and oxidative stress. This results in a progressive decline in lung function and includes symptoms such as dyspnea, chronic cough, and sputum production. Smoking is responsible for the majority of lung cancer cases. “In the United States (US), cigarette smoking is linked to about 80% to 90% of lung cancer deaths.” 4 The carcinogens in tobacco smoke induce DNA mutations, leading to uncontrolled cellular proliferation and the formation of malignant tumors. In addition, smoking is associated with

in AMA Guides® Newsletter
Laura Welch

alteration of the melanocyte would be tanning, freckles, or vitiligo, while a change in growth would be a nevus or a malignant melanoma. In the sebaceous glands, one might see seborrhea due to hyperfunction and acne due to growth at puberty. Dermatological diagnosis requires careful inspection of the skin, recognition of the principal types of lesions, and determination of distribution patterns. The morphology of the lesion and the pattern of distribution suggest the differential diagnosis. In general, it is advisable to characterize the lesion as macule, papule, change

in AMA Guides® Newsletter
Marcia Scott

Premorbid function and prior response to treatment help to ascertain a functional baseline. This includes educational, social, and interpersonal achievements, details of what happened at points of change, responsiveness to treatment, and episode prevention. The course of the patient's life helps to assess vulnerability to dysfunction and relapse. Early onset and childhood precursors presage more frequent episodes, more malignant deterioration, and fewer developmental achievements in education and relationships. Review of developmental and functional deficits in the

in AMA Guides® Newsletter
Christopher R. Brigham
and
Robert J. Barth

if a clinical presentation has plateaued; this is a state that would be consistent with a conclusion of MMI. There are potential reasons for a referral source to request an impairment rating evaluation without providing an opportunity to review medical records. Some reasons are malignant; for example, a referral source who benefits financially from higher impairment ratings might be attempting to hide issues that lead to lower impairment ratings. Other potential reasons are benign. For example, a referral source who is trying to minimize the cost of the

in AMA Guides® Newsletter