bluuebunny/crossref_metadata_2025_split huggingface dataset:
Body Member Impairments: Scheduled Awards and the Federal Employees' Compensation Act
Authors: Brigham Christopher R. 
Published: December 2020

Abstract
This article focuses on the use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in evaluating Office of Workers’ Compensation Programs (OWCP), Federal Employees’ Compensation Act (FECA) scheduled loss cases for an accepted work-related condition. Effective May 1, 2009, the Division of Federal Employees’ Compensation (DFEC), which administers FECA, adopted the AMA Guides, Sixth Edition, noting that DFEC has used the AMA Guides for more than fifty years, dating back to the first Guide for Extremities and Back (1958). The scheduled award provision of the OWCP FECA and implementing regulations set forth the number of weeks of compensation to be paid for permanent loss, or loss of use, of body members listed in the schedule. The FECA regulations that define impairment are consistent with the definition provided in the AMA Guides, Sixth Edition, except for impairments of the lungs. Also, pain is included as a component of the medical condition (diagnosis) and should not be measured separately unless the pain does not correlate with objective findings or bodily dysfunction. The article includes several special determinations under FECA, including loss of body parts, loss of hearing or vision, loss of function of bodily organs, lung impairment, and impairments in other organs.
Rating Spinal Stenosis: AMA Guides Sixth Edition Case Example
Authors: Eskay-Auerbach Marjorie 
Published: December 2020

Abstract
Spinal stenosis refers to narrowing of the spinal canal that may result in compression of the spinal cord, or cauda equina. The most common type of spinal stenosis is degenerative stenosis associated with the natural process of aging. In the lumbar spine, the narrowing may result in compression of spinal nerve roots, causing a constellation of symptoms that may include lower pack pain, neurogenic claudication, and lower extremity pain. This case illustrates the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition process of assessing impairment for spinal stenosis. The case involves a 54-year-old male truck driver whose lumbar spine was injured when he unloaded and lifted a tire; he underwent lumbar decompression at L3-4 and L4-5, and fourteen months after surgery was evaluated as being at maximum medical improvement, was able to walk, and could void spontaneously. In a one-page final medical report, the patient's physician hand wrote a note assigning 29% whole person impairment without a medical rationale to support the rating. The author of this case example first notes that the medical reporting does not support placing this patient in class 4, and the examinee's condition is most consistent with a class 1 rating for spinal stenosis. Using Section 17.3, Adjustment Grids and Grade Modifiers: Non-Key Factors, an evaluator would conclude a grade B, 6% whole person impairment for the lumbar spine.
Case Example: Lumbar Spine Injury, Treated with Spinal Injections
Authors: Brigham Christopher R. , Talmage James , Eskay-Auerbach Marjorie , McGhee Charles 
Published: December 2020

Abstract
This Case Example illustrates common questions associated with the use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, including the selection of appropriate methodology and the issue of whether spinal injections are considered to be ratable events. A 32-year-old male worker in California sustained a work-related low back injury and was examined by a chiropractic Qualified Medical Examiner (QME). The patient was referred for magnetic resonance imaging, which showed multiple lumbar disk protrusions and an L4-5 annular fissure. An epidural steroid injection at L5-S1 was of limited benefit, but bilateral L4-5 and L5-S1 facet injections, followed by chiropractic care, precluded any need for medial branch blocks or a facet rhizotomy. On presentation to the QME, the individual reported experiencing low back pain 10% of the time; this was rated 3/10 and was localized around the lumbar and lumbosacral region and was exacerbated with prolonged sitting or playing sports. The evaluator provided a rating of the lumbar spine using the range of motion (ROM) method, but the AMA Guides, Fifth Edition, states that the Diagnosis-related estimate (DRE) must be used because the impairment is due to an injury. The article demonstrates in detail how the DRE method would be applied in this case. The performance of epidural and facet injections does not constitute a ratable surgical event because these are not intradiscal injections intended to produce permanent anatomic changes in the disk.
Case Example: Adjacent Segment Disease: What Is It, and How Is It Rated?
Authors: Eskay-Auerbach Marjorie 
Published: December 2020

Abstract
The incidence of cervical and lumbar fusion surgery has increased in the past twenty years, and during follow-up some of these patients develop changes at the adjacent segment. Recognizing that adjacent segment degeneration and disease may occur in the future does not alter the rating for a cervical or lumbar fusion at the time the patient's condition is determined to be at maximum medical improvement (MMI). The term adjacent segment degeneration refers to the presence of radiographic findings of degenerative disc disease, including disc space narrowing, instability, and so on at the motion segment above or below a cervical or lumbar fusion. Adjacent segment disease refers to the development of new clinical symptoms that correspond to these changes on imaging. The biomechanics of adjacent segment degeneration have been studied, and, although the exact mechanism is uncertain, genetics may play a role. Findings associated with adjacent segment degeneration include degeneration of the facet joints with hypertrophy and thickening of the ligamentum flavum, disc space collapse, and translation—but the clinical significance of these radiographic degenerative changes remains unclear, particularly in light of the known presence of abnormal findings in asymptomatic patients. Evaluators should not rate an individual in anticipation of the development of changes at the level above a fusion, although such a development is a recognized possibility.
International Use of the AMA Guides to the Evaluation of Permanent Impairment
Authors: Ranavaya Mohammed , Brigham Christopher R. 
Published: December 2020

Abstract
In the United States, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) is used in state and federal workers’ compensation systems and in automobile casualty and personal injury arenas. The AMA Guides is used in similar ways internationally. Most workers’ compensation jurisdictions in Canada use the AMA Guides formally by statute or regulation or accept its use informally as a standard tool to rate impairment. In Australia, the AMA Guides is used in both federal (Australian Commonwealth) and individual states’ (or territories’) compensation schemes; two tables show how almost all states in Australia have legislated various editions of the AMA Guides for use in workers’ compensation and motor traffic accident compensation schemes. New Zealand's Accident Compensation Commission (ACC) previously used the AMA Guides, Fourth Edition; beginning in July 2011 ACC uses the sixth edition. Hong Kong uses the AMA Guides as a reference in evaluating workers’ compensation and motor vehicle claims; Malaysia uses the AMA Guides officially in adjudication; and impairment rating in Asian countries such as Taiwan, Korea, and Singapore are influenced by the philosophy and principles of the AMA Guides. South Africa uses the AMA Guides, Sixth Edition, to determine serious injury, and other editions are used in South Africa's workers’ compensation schemes. Many countries in Europe and the Middle East use the AMA Guides as a reference for determining impairment and in workers’ compensation and social welfare schemes.
Heart Transplant Impairment Evaluation
Authors: Demeter Stephen L. 
Published: December 2020

Abstract
The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not specifically address how to rate heart transplants, but by applying principles used in rating similar illnesses, the evaluator can assess permanent impairment. The fourth and fifth editions of the AMA Guides contained directions for rating impairment created by a heart transplantation. Since these editions appeared, more heart, kidney, lungs, hands, and even faces have been transplanted. The AMA Guides, Sixth Edition, provides guidance only on rating individuals who received a kidney transplant, but this article describes a method for rating individuals following cardiac transplant and using principles in the cardiovascular chapter in the sixth edition of the AMA Guides. The steps are as follows: 1) rate using Table 4-7 Criteria for Rating Impairment due to Cardiomyopathies; 2) use classes 2, 3, or 4 for rating the posttransplant individual; 3) an individual who is posttransplant with totally normal cardiac physiological function is rated as class 2, level A; 4) combine with the burden of treatment compliance impairment caused by antirejection medications; and 5) combine with impairment found in any other organ system resulting from medications used to treat the heart, infections, and rejection. This article shows that if a specific, medically documented injury or illness is not addressed in the AMA Guides, the evaluator can apply the rating principles used in rating similar conditions in order to determine impairment.
Can Acromioplasty Result in Impairment?
Authors: Melhorn J. Mark , Brooks Charles N. , Talmage James B. 
Published: December 2020

Abstract
To determine if an acromioplasty is impairing, an evaluator must know shoulder anatomy, the diagnosis or diagnoses, what treatment was provided, and the patient's present status. Over time, the earlier classification of shoulder impingement has been modified, and the current classification was adopted in 1994. At present, acromioplasty often is not the primary surgery but rather is one component of subacromial decompression with or without concomitant rotator cuff and/or intra-articular shoulder surgery. Until the sixth edition, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) did not address the question whether acromioplasty itself constitutes an impairment. In the fourth and fifth editions of the AMA Guides, although open or arthroscopic acromioplasty commonly results in temporary shoulder pain, stiffness, and weakness, the surgical procedure itself, barring complication, results in no permanent impairment. According to the AMA Guides, Sixth Edition, if an acromioplasty eliminated impingement and resulted in no pain or significant objective findings at maximal medical impairment, no impairment occurred. Diagnosis-based impairment is considered the rating method of choice, but range of motion is used primarily in the physical examination adjustment grid. Further, surgical error and/or complications may result in ratable motion and/or strength deficits. The AMA Guides, Fourth and Fifth Editions, also provide a means to rate impairment due to any concomitant distal clavicular resection.
Sixth Edition and Illinois
Authors: Brigham Christopher R. 
Published: December 2020

Abstract
The state of Illinois has undergone major workers’ compensation reform with the passage of House Bill 1698, and from September 1, 2011, one of the factors used to determine a permanent partial disability (PPD) rating is an impairment evaluation according to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. Previously, the Illinois Workers’ Compensation Commission used a body of case law that set forth general parameters to guide PPD assessment, and the Commission would not allow testimony for any doctor's opinion regarding the percent of disability. Adding the use of the AMA Guides should increase the reliability of these awards. Impairment rating is only one factor that will be considered in determining the level of PPD, and other factors include the injured employee's occupation; age at the time of injury; the employee's future earning capacity; and evidence of disability corroborated by the treating physician's medical records. No single factor should be the sole determinant of disability, and the fact finder must use judgment and must document the rationale for the decision. Basing the impairment rating on the AMA Guides as a starting point should result in both a more valid and more reliable process to determine PPD.
Malingering and Other Validity Considerations: With an Emphasis on Document Review
Authors: Patterson Chris Stewart , Barth Robert J. , Brigham Christopher R. , Talmage James B. , Leclair Steven , Coupland Michael 
Published: December 2020

Abstract
Many of the methods used to assess impairment rely on the completeness, accuracy, and reliability of patients’ self-presentations, and evaluators should be able to identify behavioral factors such as illness behavior and malingering; the latter is not ratable, but its presence complicates appropriate case management. This article focuses on the clinical data and the analysis that can be helpful in identifying malingering, as well as validity problems during document and medical file reviews. According to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, examiners always should be aware of the possibility of malingering during impairment evaluations, and the possibility of avoiding responsibility and/or obtaining monetary awards increases the likelihood of exaggeration and/or malingering. Current methods for assessing malingering in general assess the probability of malingering based on comparisons to research statistics and free the evaluator from any reliance on expert opinion. Correlating multiple clinical sources is useful in assessing the validity of a clinical presentation and includes the individual's pre-existing status; information about the injury; the history of the presenting illness, past medical and social histories, physical examination, questionnaires and scales, functional capacity evaluations, and video surveillance. Coherence analysis is a method of clinical data review that uses multiple themes to determine if data provide an integrated presentation. Evaluators should highlight issues of discontinuity, inconsistencies, incongruencies, noncompliance, or poor effort.
Rating Distal Clavicle Resection
Authors: Books Charles N. , Talmage James B. , Melhorn J. Mark 
Published: December 2020

Abstract
Indications for excision of the distal clavicle include symptomatic degenerative arthritis of the acromioclavicular joint, impingement syndrome, and osteolysis of the distal clavicle if nonoperative treatment has failed. Distal clavicular resection (DCR), one could argue, is by definition an impairment because of the loss of a portion of a body part, the clavicle. Yet a competently performed and uncomplicated DCR generally results in improved function, not loss of use. DCR was first mentioned in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, which stated that a resection arthroplasty of the acromioclavicular joint warrants 10% upper extremity impairment (UEI). Rating DCR using the AMA Guides, Fifth Edition, is almost the same as using the fourth edition, but evaluators can use one of two approaches: The rating physician can select a 3% rating for DCR using the fifth edition and claim to be literally following the instructions and providing a sensible rating in view of the generally good results reported in the orthopedic literature following a DCR. Alternatively, a rating physician who is aware of the historical precedent underlying the 10% UEI in Table 16-27 could cite this and the absence of an instruction in the Arthroplasty section to justify a 10% impairment rating. In the sixth edition, DCR is a key factor in classifying an acromioclavicular joint injury or disease but is disregarded in the rating of rotator cuff or glenohumeral pathology.
Determining Normal for Upper and Lower Limb Motions
Authors: Brooks Charles N. , Brigham Christopher R. 
Published: December 2020

Abstract
Normal joint motions vary from one person to another and depend on multiple factors, which raises issues when evaluators attempt to address issues of causation and apportionment. Although the causation and apportionment of joint motion deficits were not addressed in the fourth and earlier editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), the fifth and sixth editions took three possibilities into consideration when they provided instructions about how to evaluate impairment due to diminished mobility of upper and lower limb joints. Evaluating physicians must consider whether: 1) the motion deficit existed before the injury or illness in question or if the deficit was caused by individual variation, aging, disease, trauma, and/or other cause; 2) the motion deficit was caused by the injury or illness that is at issue or is in question; and 3) a lesser, pre-existing motion deficit existed before the current injury or illness was aggravated (permanently increased). Because of variations in normal joint motions among individuals, examiners should measure the motions of the uninvolved as well as the involved joints, using the former to define normal. Any motion impairment of the uninvolved joint is subtracted from that for the involved joint to determine the net impairment. Examples from the fifth and sixth editions show applications of the AMA Guides to two sample cases.
Combining Values Chart
Authors: Brigham Christopher R. 
Published: December 2020

Abstract
Evaluating physicians may need to account for the effects of multiple impairments using a summary value. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, the Combined Values Chart provides a method to combine two or more impairment percentages based on the formula A + B(1 – A) = the combined value of A and B. Using the Combined Values Chart and this formula, physicians can combine multiple impairments so that the whole person impairment is equal to or less than the sum of all the individual impairment values. The AMA Guides, Sixth Edition, specifies that “impairments are successively combined by first combining the largest number with the next largest remaining number, and then further combining it with the next largest remaining number … until all given impairment numbers are combined.” Impairment values within a region generally are combined and converted to whole person permanent impairment before being combined with values from other regions. The article reviews the AMA Guides, Sixth Edition, approach to combining upper extremity impairments, lower extremity impairments, and combining spinal impairments.
Evaluating Causation for the Opposite Lower Limb
Authors: Brigham Christopher R. , Brooks Charles N. , Talmage James B. 
Published: December 2020

Abstract
Causation analysis always should be based on current scientific evidence and the facts of a specific case rather than common opinions or beliefs, eg, the myth that “favoring” one lower extremity often results in injury or illness of the opposite lower limb. Temporal sequence does not prove causation, and in causation analysis one also must consider temporal disparity: Was an injury or exposure likely to cause the condition in question, or is there another, more probable, cause? To conclude that a given cause and effect are etiologically associated with a reasonable degree of medical probability or certainty (ie, more than 50% probability), all three of the following criteria must be met: the cause is medically probably; the effect is medially probably; and the cause and effect probably are etiologically related. That is, causation analysis must be based on an analytical approach and not patient history alone. The medical literature reveals no generally accepted studies that support a causal relationship based on an individual's “favoring” one extremity. Rather, evaluators must base conclusions on scientific evidence and facts of the case at hand rather than relying solely on patient history or false logic such as the post hoc propter hoc fallacy.
“Double-Dipping”
Authors: Demeter Stephen L. 
Published: December 2020

Abstract
The goal of impairment assessment is to accurately estimate the loss of structure and/or function due to an injury or illness. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) sometimes provides two or more methods for rating a given condition, or, in the case of two or more impairing conditions, it may be inappropriate to rate less significant conditions if the rating for the primary impairment already takes into account the deficit(s). Either scenario offers opportunities for “double-dipping” or rating the same impairment more than once. Duplicative ratings commonly occur when two or more impairing conditions are present in a single organ system and even more often if multiple organ systems are involved. Because of methodological changes, ratings using the AMA Guides, Sixth Edition, are less susceptible to double-dipping than those from earlier editions, especially musculoskeletal ratings. To avoid duplication, the rater must look closely at all elements included in the impairment classes and determine if any similarity exists in the other organ systems or conditions rated (eg, is the patient's coronary artery disease responsible for the diminished exercise capacity, or is it the cardiomyopathy, or is it chronic obstructive pulmonary disease). When two or more conditions are present, evaluators should rate the higher or highest impairment and then eliminate, as much as possible, the influence of similar symptoms, signs, or diagnostic test abnormalities when rating the lower impairments.
American Medical Association Impairment Ratings and Earnings Losses Due to Disability
Authors: Seabury Seth A. , Neuhauser Frank , Nuckols Teryl 
Published: December 2020

Abstract
The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) has been criticized because it was designed to measure the severity of impairment (loss of function of a body part) rather than disability (eg, inability to work), and the AMA Guides uses whole person impairment that accords higher priority to body regions that are deemed more important to functionality even though no objective evidence supports the relative importance of different body regions. This article reports on a study funded by the California Commission on Health and Safety and Workers’ Compensation (CHSWC) to address these concerns. The study found that the AMA Guides, Fifth Edition, is an effective tool for ranking the effect of physical impairments on the ability to work; people with higher physical impairment ratings, measured using the AMA Guides, consistently had higher earnings losses. The authors conclude that ratings based on the AMA Guides, Fifth Edition, probably are more accurate and consistent than ratings conducted under the previous system in California, the system used by the Veterans Administration, or systems used by Wisconsin and Florida in the 1960s. The authors also identified significant challenges to using ratings based on the AMA Guides to determine financial compensation, particularly across body regions, and some evidence suggests that the relationship between impairment ratings and losses was attenuated at higher ratings.