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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
Restricted access
Stephen L. Demeter

example, if a person with CAD has symptoms justifying inclusion in NYHA class IV but also has severe shortness of breath caused by chronic obstructive pulmonary disease (COPD), it would be duplicative to use this historical parameter to modify both the CAD and COPD ratings. The impairment with the higher rating should be modified and this parameter ignored in rating the lesser impairment. Because of methodological changes, ratings using the Sixth Edition are less susceptible to double-dipping than those from earlier editions, especially musculoskeletal ratings

in AMA Guides® Newsletter
Stephen L. Demeter

respiratory disorders, as found in the original JAMA article and the Second Edition of the Guides , the concept of asthma impairment rating has made significant strides. The use of the examinee's history has come full circle from being part of the impairment rating process to being excluded to being reintroduced in the Sixth Edition. The concept that asthma is not easily rated using methods applicable to other pulmonary diseases was introduced in the Fifth Edition and modified for use in the Sixth Edition. Future editions will likely refine the medication usage table to

in AMA Guides® Newsletter
Christopher R. Brigham

Abstract

Cardiopulmonary exercise stress testing (CPET) provides objective data to assess cardiac and pulmonary impairment. This article discusses changes in the CPET section of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). The explanation of CPET in the AMA Guides, Sixth Edition, adds a single word, “static,” that significantly effects how this test should be conducted. Routine pulmonary function tests (PFTs) provide information about a person's ability to breathe, eg chronic obstructive pulmonary disease or asthma can stratify the severity of these diseases; they do not measure the ability of the lungs or heart to provide adequate oxygenation to metabolizing tissues. Static tests of lung function are the norm when diagnosing asbestosis, and the typical abnormalities seen are restriction, some airflow obstruction, and a diminished diffusing capacity. These abnormalities correlate linearly with the degree of abnormality found radiographically. In individuals with unexplained shortness of breath with exertion or fatigue that is not easily explained in the medical records, a CPET will allow secure diagnosis of causation. Thus CPET is a powerful tool to explain shortness of breath with exertion or fatigue, and CPET has a role in the impairment rating process of all individuals with interstitial lung diseases and in selected individuals with unexplained symptoms.

in AMA Guides® Newsletter
J. Mark Melhorn
,
James B. Talmage
,
William E. Ackermann III
,
Mark H. Hyman
, and
Richard T. Katz

. The robustness of this approach is most evident in Chapters 8 through 10, examining the causal relationship between the work place and disorders of the spine, upper limb, and lower limb. The book then loses some of its impetus in other organ systems: “general” musculoskeletal problems such as fibromyalgia, cardiovascular and pulmonary disease, neurological and rheumatological diseases. As research related to work-relatedness is less developed in these areas, the chapters draw weaker conclusions and make less of an impact. However the chapters have been upgraded

in AMA Guides® Newsletter
JM Melhorn
and
WE Ackerman

arthritis x x x xx x x Meniscal disorders xx xx Plantar fasciitis x = some evidence, xx = strong evidence, xxx = very strong evidence (absence of x indicates insufficient evidence to support a risk factor) 1 including previous meniscectomy The book then loses some of its impetus as it delves into other organ systems: “general” musculoskeletal problems such as fibromyalgia, cardiovascular and pulmonary disease, neurological and rheumatological diseases. As research

in AMA Guides® Newsletter

Orthopedic Institute Home Page http://www.scoi.com/ UNC's Online Neurosurgery Resident's Handbook–Nerve and Main Root Supply of Muscles http://sunsite.unc.edu/Neuro/handbook/nerve.html UNC's Online Neurosurgery Resident's Handbook–Spinal Root Syndromes http://sunsite.unc.edu/Neuro/handbook/rh-root.html Psychology Mental Health http://www.mentalhealth.com Pulmonary Disease Inhalation Diseases of the Lung http://nuc-med-read.uthscsa.edu/williams/chest/Inhale.htm Occupational Asthma: A Primer http

in AMA Guides® Newsletter
Laura Welch

assessment, they can be used to fit the worker to the job. An FCE is most often used for assessment of a musculoskeletal disorder, however, rather than a cardiac or pulmonary disease. Validity is less clear in this arena. If we are measuring the capacity of a specific joint and comparing it to a specific job task, we can generally be sure the test will be valid. For example, a plumber with a rotator cuff tear may need to generate a specific force in an overhead position in order to perform the essential functions of his job. Force at the shoulder can be measured, and

in AMA Guides® Newsletter
James B. Talmage
,
Mark H. Hyman
,
Christopher R. Brigham
,
Sarah H. Gulick
, and
Leslie Burton

, self-paced, until 6 minutes have elapsed. The total distance covered in 6 minutes of walking can be recorded and compared to established norms, as this is the well-researched “6-minute walk test.” 20 Patients post-COVID-19 without other known causes of exertional dyspnea (eg, anemia, heart disease, and so on) who are intolerant of the 100-foot exercise test may need to be evaluated further by a cardiologist or pulmonologist before exercise rehabilitation. After an appropriate evaluation, patients with documented cardiac disease and/or pulmonary disease might be

in AMA Guides® Newsletter