bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Biopsychosocial Model of Sickness and Disability
Authors: Waddell Gordon , Burton A. Kim , Aylward Mansel 
Published: December 2020

Abstract
Despite improvements in objective measures of impairment, health, and working conditions, long-term incapacity and ill-health retirement are major problems in all western societies. This article explores three models that address disability: the medical, social, and biopsychosocial models. The medical model identifies the sequence from disease that causes an impairment to a disability that leads to incapacity; this model works best when identifiable pathology permits objective diagnosis and assessment but is inappropriate for many common health problems, particularly those that are subjective or when treatment is symptomatic and often ineffective. The social model is widely accepted as the basis for social inclusion and antidiscrimination policies but cannot be operationalized as the basis for individual entitlement for incapacity benefits. The biopsychosocial model attempts to tack account of biological, psychological, and social dimensions of health and is reflected in the International Classification of Functioning, Disability, and Health (ICF), which is the contemporary model of disablement used in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. Powerful links exist among poor health, disability, social and regional disadvantage, worklessness, and poverty. Vocational rehabilitation, in the biopsychosocial model, reverses the question of why people develop long-term incapacity and instead asks why people with common health problems do not recover as expected. The answer involves addressing the biopsychosocial obstacles that delay or prevent expected recovery and requires a fundamental cultural shift in how we perceive and manage common health problems.
Commentary
Authors: Katz Richard T. 
Published: December 2020

Abstract
The author, who is the editor of the Mental and Behavioral Disorders chapter of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, comments on the previous article, Assessing Mental and Behavioral Disorder Impairment: Overview of Sixth Edition Approaches in this issue of The Guides Newsletter. The new Mental and Behavioral Disorders (M&BD) chapter, like others in the AMA Guides, is a consensus opinion of many authors and thus reflects diverse points of view. Psychiatrists and psychologists continue to struggle with diagnostic taxonomies within the Diagnostic and Statistical Manual of Mental Disorders, but anxiety, depression, and psychosis are three unequivocal areas of mental illness for which the sixth edition of the AMA Guides provides M&BD impairment rating. Two particular challenges faced the authors of the chapter: how could M&BD disorders be rated (and yet avoid an onslaught of attorney requests for an M&BD rating in conjunction with every physical impairment), and what should be the maximal impairment rating for a mental illness. The sixth edition uses three scales—the Psychiatric Impairment Rating Scale, the Global Assessment of Function, and the Brief Psychiatric Rating Scale—after careful review of a wide variety of indices. The AMA Guides remains a work in progress, but the authors of the M&BD chapter have taken an important step toward providing a reasonable method for estimating impairment.
Relevance of the Social Security Listings in the Assessment of Severity of Mental and Behavioral Impairments per the Fourth and Fifth Editions
Authors: Leclair Steven W. , Leclair Norma J. 
Published: December 2020

Abstract
Establishing a valid and reliable impairment rating for persons with mental and behavioral disorders is particularly challenging. This article focuses on the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, Chapter 14, Mental and Behavioral Disorders; because of similarities between the fourth and fifth editions, most comments here apply as well to the fifth edition. The section regarding mental and behavioral disorders is based in the US Social Security Administration (SSA) disability determination. The AMA Guides measures impairment in the same four areas of functioning designated by SSA: activities of daily living; social functioning; concentration, persistence, and pace (ie, focused attention); and deterioration or decompensation in work-like settings (“adaptation”). The assessment of severity of impairment is based on the five-level SSA approach and is applied to each of the four areas of functioning. The authors define and interpret the practical meanings of terminology in the AMA Guides associated with classes of severity: no impairment (self-explanatory); mild impairment (compatible with most useful functioning); moderate impairment (compatible with some but not all useful functioning); marked impairment (significantly impedes useful functioning); and extreme impairment (not compatible with useful functioning). Impairment ratings are truly applicable only when clinicians can approach the process in a consistent manner using consistent terminology and methodology; the latter two will improve both the understanding of the rating process and its reliability and validity.
Impairment Tutorial: Lower Extremities Impairment Evaluation: Overview of Sixth Edition Approaches
Authors: Brigham Christopher R. 
Published: December 2020

Abstract
The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, takes approaches to the lower extremities that are consistent with Chapter 15, Upper Extremities (reviewed in the March/April 2008 issue of The Guides Newsletter). Because there is a comparatively smaller spectrum of diagnoses in the lower extremities, Chapter 16 is less complex and is shorter than Chapter 15. The purposes of the lower extremity are transfer and mobility, and, in comparison to the upper extremity, the lower extremity provides greater stability than flexibility. This chapter's principles of assessment define the standards for interpreting symptoms and signs, functional history, physical examination, and clinical studies. Examiners may use the Lower Limb Instrument developed by the American Academy of Orthopaedic Surgery as an adjunct to defining functional ability, but values are not provided to define a specific grade modifier. Most lower extremity impairments are based on Diagnosis-related impairments, and an impairment example case demonstrates the use of the Knee Regional Grid to asses a partial meniscus repair. An associated table illustrates the resulting whole person impairment values associated with these examples and gives the probable impairments based on the fifth edition. The article also discusses impairments of the peripheral nerves, amputation, and range of motion. Mastery of one chapter of the AMA Guides facilitates performing ratings using other chapters.
Impairment Tutorial: Headache Impairment
Authors: Subin Kenneth , Brigham Christopher R. 
Published: December 2020

Abstract
The approach to assessing impairment for headaches differs among the fourth, fifth, and sixth editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). In summary, the fourth edition provides only a qualitative, nonnumeric rating. In the fifth edition, an examiner can give up to 3% whole person permanent impairment. Using the sixth edition of the AMA Guides, an examiner may determine up to 5% whole person permanent impairment for migraine headaches for Chapter 13 and up to 3% whole person impairment for other headaches according to Chapter 3. With respect to the AMA Guides, Fourth Edition, unless other objective features can be rated according to specific organ dysfunction, headache impairment is a qualitative, nonnumeric rating, and “The vast majority of patients with headache[s] will not have permanent impairments.” In some defined cases, the fifth edition facilitates calculation of a pain related impairment score (that specifically is not an impairment rating) that is used to describe the severity of the pain, for which up to 3% whole person impairment may be provided. The sixth edition of the AMA Guides provides a quantitative whole person impairment rating up to 5% whole person impairment for migrainous headaches and 3% whole person impairment for nonmigrainous headaches.
Spine Impairment Evaluation: Sixth Edition Approaches
Authors: Uejo Craig , Eskay-Auerbach Marjorie , Brigham Christopher R. 
Published: December 2020

Abstract
Evaluators who use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, should understand the significant changes that have occurred (as well as the Clarifications and Corrections) in impairment ratings for disorders of the cervical spine, thoracic spine, lumbar spine, and pelvis. The new methodology is an expansion of the Diagnosis-related estimates (DRE) method used in the fifth edition, but the criteria for defining impairment are revised, and the impairment value within a class is refined by information related to functional status, physical examination findings, and the results of clinical testing. Because current medical evidence does not support range-of-motion (ROM) measurements of the spine as a reliable indicator of specific pathology or permanent functional status, ROM is no longer used as a basis for defining impairment. The DRE method should standardize and simplify the rating process, improve validity, and provide a more uniform methodology. Table 1 shows examples of spinal injury impairment rating (according to region of the spine and category, with comments about the diagnosis and the resulting class assignment); Table 2 shows examples of spine impairment by region of the spine, class, diagnosis, and associated whole person impairment ratings form the sixth and fifth editions of the AMA Guides.
Rating Spinal Nerve Extremity Impairment Using the Sixth Edition (Authoritative Article*)
Authors: Brigham Christopher R. 
Published: December 2020

Abstract
The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, does not provide a separate mechanism for rating spinal nerve injuries as extremity impairment; radiculopathy was reflected in the spinal rating process in Chapter 17, The Spine and Pelvis. Certain jurisdictions, such as the Federal Employee Compensation Act (FECA), rate nerve root injury as impairment involving the extremities rather than as part of the spine. This article presents an approach to rate spinal nerve impairments consistent with the AMA Guides, Sixth Edition, methodology. This approach should be used only when a jurisdiction requires ratings for extremities and precludes rating for the spine. A table in this article compares sensory and motor deficits according to the AMA Guides, Sixth and Fifth Editions; evaluators should be aware of changes between editions in methodology used to assign the final impairment. The authors present two tables regarding spinal nerve impairment: one for the upper extremities and one for the lower extremities. Both tables were developed using the methodology defined in the sixth edition. Using these tables and the process defined in the AMA Guides, Sixth Edition, evaluators can rate spinal nerve impairments for jurisdictions that do not permit rating for the spine and require rating for radiculopathy as an extremity impairment.
Impairment Rating in California: Analysis of the Almaraz and Guzman Decision and Impact on the Use of the AMA Guides, Fifth Edition
Authors: Brigham Christopher R. , Uehlein W. Frederick 
Published: December 2020

Abstract
The Sate of California Workers’ Compensation Appeals Board (WCAB) in a February 3, 2009, decision in the consolidated cases of Almaraz vs SCIF et al. and Guzman vs Milpitas Unified School District (Almaraz/Guzman) concluded that the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, portion of the 2005 Permanent Disability Rating Schedule is rebuttable. The effects of this decision are significant for California and could catalyze challenges regarding use of the AMA Guides in other jurisdictions. Unavoidable consequences of this decision include increased confusion in the assessment of permanent impairment and disability, far more litigation, increased medical and legal costs, and delayed case closure. The consequence of the WCAB's interpretation is significant financial and human costs, including inaccurate expectations by employees regarding the amount of benefits they may reasonably expect, delays in obtaining these benefits, and perceptions of being significantly permanently disabled. Further, the WCAB decision confuses the concepts of “work impairment” and “disability” and presents misleading information about the AMA Guides and its role in assessing impairment. The WCAB decision will be appealed to the Supreme Court, and it likely will be overturned. In the interim, stakeholders must continue to ensure that impairment ratings and resulting disability ratings are accurate. The article reports on and comments in depth regarding the WCAB Decision and highlights errors in the decision.
Obstacles to Claiming Permanence and Injury-Relatedness for “Posttraumatic” Headache
Authors: Barth Robert J. 
Published: December 2020

Abstract
“Posttraumatic” headaches claims are controversial because they are subjective reports often provided in the complex of litigation, and the underlying pathogenesis is not defined. This article reviews principles and scientific considerations in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) that should be noted by evaluators who examine such cases. Some examples in the AMA Guides, Sixth Edition, may seem to imply that mild head trauma can cause permanent impairment due to headache. The author examines scientific findings that present obstacles to claiming that concussion or mild traumatic brain injury is a cause of permanent headache. The World Health Organization, for example, found a favorable prognosis for posttraumatic headache, and complete recovery over a short period of time was the norm. Other studies have highlighted the lack of a dose-response correlation between trauma and prolonged headache complaints, both in terms of the frequency and the severity of trauma. On the one hand, scientific studies have failed to support the hypothesis of a causative relationship between trauma and permanent or prolonged headaches; on the other hand, non–trauma-related factors are strongly associated with complaints of prolonged headache.
Commentary
Authors: Katz Richard T. 
Published: December 2020

Abstract
Patients may complain of daytime drowsiness associated with a painful musculoskeletal disorder, but these complaints regard an activity of daily living (ADL) and do not result in a separate sleep impairment rating. This article focuses on sleep impairment resulting from documented nervous system dysfunction or sleep apnea. Because the accuracy and reliability of sleep testing are critical for the proper diagnosis and impairment rating of a sleep disorder, sleep testing should be completed at a center certified by the American Academy of Sleep Medicine. In both the fifth and sixth editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), neurologically based sleep disorders are rated using Chapter 13, and sleep apnea is rated using Chapter 5. The AMA Guides, Sixth Edition, does provide a rating value of up to 3% whole person impairment for sleep apnea related impairment, but the fifth edition does not provide any numerical rating value. A sleep disturbance not related to neurologically based dysfunction or apnea should be considered according to its effects on ADLs for the primary pathology identified or diagnosed. Expert understanding of sleep disorders is crucial, as is the specialized experience of a credentialed sleep laboratory. Subjective questionnaires can be used to screen for sleep disorders or excessive daytime sleepiness, but formal sleep studies are necessary to confirm any diagnosis and to provide an objective basis to assess permanent impairment.
A Historical Review of Complex Regional Pain Syndrome in the “Guides Library”
Authors: Barth Robert J. 
Published: December 2020

Abstract
Complex regional pain syndrome (CRPS) is a controversial, ambiguous, unreliable, and unvalidated concept that, for these very reasons, has been justifiably ignored in the “AMA Guides Library” that includes the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), the AMA Guides Newsletter, and other publications in this suite. But because of the surge of CRPS-related medicolegal claims and the mission of the AMA Guides to assist those who adjudicate such claims, a discussion of CRPS is warranted, especially because of what some believe to be confusing recommendations regarding causation. In 1994, the International Association for the Study of Pain (IASP) introduced a newly invented concept, CRPS, to replace the concepts of reflex sympathetic dystrophy (replaced by CRPS I) and causalgia (replaced by CRPS II). An article in the November/December 1997 issue of The Guides Newsletter introduced CRPS and presciently recommended that evaluators avoid the IASP protocol in favor of extensive differential diagnosis based on objective findings. A series of articles in The Guides Newsletter in 2006 extensively discussed the shortcomings of CRPS. The AMA Guides, Sixth Edition, notes that the inherent lack of injury-relatedness for the nonvalidated concept of CRPS creates a dilemma for impairment evaluators. Focusing on impairment evaluation and not on injury-relatedness would greatly simplify use of the AMA Guides.
Guides Question and Answer
Authors: Talmage James B. 
Published: December 2020

Abstract
Sun-related skin disorders are rated, along with all dermatological disorders, using Chapter 8, The Skin, in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) and are based on three factors: the presence of a skin disorder (signs and symptoms); need for treatment; and interference with activities of daily living (ADL). This Case Presentation illustrates some of the challenges that an evaluator new to the rating process may encounter and clarifies that precautionary guidance to reduce sun exposure is not equivalent to interference in ADL and the assignment of impairment. The patient has been a firefighter since 1986, previously worked in construction, lives in Southern California, and surfed recreationally until six or seven years ago. He presents with new lesions of his skin following sun exposure and has been followed by his primary care physician and his dermatologist regarding his basal cell carcinoma and cryosurgeries to treat actinic keratoses. The evaluator determines class 3, 25% impairment, which precludes ADL in the midday sun. The authors note two immediate red flags: Misnaming the AMA Guides is a typical beginner's error, and the evaluation provides no reference to specific criteria or tables even though the State of California uses the fifth edition to rate workers’ compensation cases.
Impairment Rating and Spinal Cord Injuries: Revisiting the Guides
Authors: Katz Richard T. 
Published: December 2020

Abstract
This article addresses some criticisms of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) by comparing previously published outcome data from a group of complete spinal cord injury (SCI) persons with impairment ratings for a corresponding level of injury calculated using the AMA Guides, Sixth Edition. Results of the comparison show that impairment ratings using the sixth edition scale poorly with the level of impairments of activities of daily living (ADL) in SCI patients as assessed by the Functional Independence Measure (FIM) motor scale and the extended FIM motor scale. Because of the combinations of multiple impairments, the AMA Guides potentially overrates the impairment of paraplegics compared with that of quadriplegics. The use and applicability of the Combined Values formula should be further investigated, and complete loss of function of two upper extremities seems consistent with levels of quadriplegia using the SCI model. Some aspects of the AMA Guides contain inconsistencies. The concept of diminishing impairment values is not easily translated between specific losses of function per organ system and “overall” loss of ADLs involving multiple organ systems, and the notion of “catastrophic thresholds” involving multiple organ systems may support the understanding that variations in rating may exist in higher rating cases such as those that involve an SCI.
Dispute Resolution as a Creator of Needless Disability
Authors: Aurbach Robert 
Published: December 2020

Abstract
When injured persons feel pain and a physician tells them that they have a permanent condition, the feeling of pain can become associated over time with the diagnosis, the emotional response to the diagnosis, and factors associated with the diagnosis (including helplessness, fear, anger and overwhelming stress). Even the language associated with the process can be misleading: To some, the phrase “maximum medical improvement” may have the ominous ring of a life sentence with a judgment that they have reached the highest potential for recovery, even if this is not the case. The US legal system often contributes to needless disabling, to the extent that the author coins the term “attorneyogenic disability.” Delaying dispute resolution following disputes in the case causes harm by creating a period when injured workers may obsess about their condition, the people who have wronged them, and the unfairness of the system in failing to compensate them. As delays stretch on, the individual's perception of physical symptoms may become habitual in a complex association of thoughts, feelings, and emotions that affect the worker's neural network. Finally, the legal system stops when the claim is resolved, and the patient's advocate has no systemic motivation to assist after the claim is completed. Planning for functional adaptation and treatment after the dispute resolution often is lacking, especially after the individual has been exposed both to catastrophic thinking in the courtroom and multiple medical evaluations and treatment protocols.
Behavioral Factors Impact Impairment and Disability Evaluation
Authors: Ensalada Lee 
Published: December 2020

Abstract
Illness behavior refers to the ways in which symptoms are perceived, understood, acted upon, and communicated and include facial grimacing, holding or supporting the affected body part, limping, using a cane, and stooping while walking. Illness behavior can be unconscious or conscious: In the former, the person is unaware of the mental processes and content that are significant in determining behavior; conscious illness behavior may be voluntary and conscious (the two are not necessarily associated). The first broad category of inappropriate illness behavior is defensiveness, which is characterized by denial or minimization of symptoms. The second category includes somatoform disorders, factitious disorders, and malingering and is characterized by exaggerating, fabricating, or denying symptoms; minimizing capabilities or positive traits; or misattributing actual deficits to a false cause. Evaluators can detect the presence of inappropriate illness behaviors based on evidence of consistency in the history or examination; the likelihood that the reported symptoms make medical sense and fit a reasonable disease pattern; understanding of the patient's current situation, personal and social history, and emotional predispositions; emotional reactions to symptoms; evaluation of nonphysiological findings; results obtained using standardized test instruments; and tests of dissimulation, such as symptom validity testing. Unsupported and insupportable conclusions regarding inappropriate illness behavior represent substandard practice in view of the importance of these conclusions for the assessment of impairment or disability.