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Jesse E. Bible
,
Dan M. Spengler
, and
Hassan R. Mir

. This means that the worker has been deemed to have disability to the extent that they will not be able to work again in the open labor market. Most states compensate these individuals with two-thirds of the previously earned average wages, within the bounds of set maximum and minimum limits. Whereas some states limit the duration of payments, others provide lifetime compensation for injured workers. Independent medical evaluation An independent medical evaluation (IME) is an examination and review by a physician who is not involved in the treatment of the

in AMA Guides® Newsletter
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Usually books are reviewed within a year or less of their publication. In keeping with tradition, this review focuses on the latest 1999 supplement to Babitsky and Sewall's primary text, published in 1992. The primary 1992 text is included to contrast it to the recent supplement. Babitsky and Seawall have given the independent medical evaluation (IME) physicians and functional capacity evaluators (FCE) an invaluable tool necessary for understanding the Guides to the Evaluation of Permanent Impairment , its use in the disability determination process, and

in AMA Guides® Newsletter
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James B. Talmage

third) opinion should easily establish the fact that the first physician's stated opinions differ from consensus. If, however, there is no consensus, then multiple physician opinions will differ, and even “fourth opinions” will leave the gray-area issues in dispute. There have been few studies on physician agreement on impairment rating. Some of these were previously reviewed in the Guides Newsletter . 1 Two recent articles focus on physician agreement in surgical indications for sciatica, and work recommendations for chronic back pain patients-both issues on

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, interstitial cystitis, cancer pain, etc. Four separate chapters cover the problem of spinal pain, and the pharmacology of analgesic drugs is reviewed well in two chapters. Sometimes, however, the individual with chronic pain and difficulty functioning is much more complex, and impairment and ability/disability issues are much more difficult to decide. In these cases, pain behavior is prominent, and most of the “8 D—s” of the Chronic Pain Syndrome (4th ed., 308-9) are present. While the Guides discuss Chronic Pain Syndrome in 12 pages, many physicians feel it does not

in AMA Guides® Newsletter
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Casebook, 2nd Edition is available through the American Medical Association and can be ordered via a toll-free number, (800) 621-8335, or by visiting the AMA website at www.amapress.com . This review was reprinted with permission from: May RV. Disability Eval and Rehab Review. 2002;5:4-5. ( www.nadep.com )

in AMA Guides® Newsletter
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James B. Talmage

back pain patient disability rating reports. The authors picked the 42 best (most complete) reports. Multiple physicians reviewed each report and rated each individual's disability. An average of 14 physicians rated each case, with the ratings differing considerably. The difference between the lowest and the highest ratings assigned to the same case averaged 43%. This study was one factor in California revising its impairment rating system. Authors of the studies in West Virginia and Iowa surveyed physicians on their permanent rating practices for chronic low back

in AMA Guides® Newsletter
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James B. Talmage

Behavioral Responses to Examination, A Reappraisal of the Interpretation of “Nonorganic Signs.” Main CJ, Waddell G (Spine, 1998;23, 2367-2371). In 1980, orthopedist Gordon Waddell described physical examination signs that should alert physicians to the potential presence of “nonorganic” factors. Eighteen years later, the present article offers an update on how these signs have come to be used, both appropriately and inappropriately, in assessing individuals with lumbar spine complaints. It also reviews the process by which the 8 “Waddell—s Signs” were

in AMA Guides® Newsletter
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James B. Talmage

significantly (4th ed., 170). Restrictions apply to activities the individual can perform, but because of risk assessment, the physician recommends against such activity. Risk assessment is much less measurable than capacity, so restrictions involve more judgment. The 26th Bethesda Conference panel reviewed the literature and reached consensus on safe recommendations for athletes with cardiovascular disease. While the focus of the conference was on participants in competitive athletics, they noted, we do recognize the likelihood that some practitioners will choose to

in AMA Guides® Newsletter
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James B. Talmage

done for systems in which causation is accepted and the condition is “compensable.” If an individual with one of these syndromes does require an impairment rating, the advice in these reviews would be helpful to the physician tasked with the impairment rating. -James B. Talmage, MD

in AMA Guides® Newsletter