Opinion ID: 2539317
Heading Depth: 1
Heading Rank: 3

Heading: The AMA Guides, fifth edition

Text: The AMA Guides was originally published in 1971 to establish a standardized, objective approach to evaluating medical impairments for purposes of workers' compensation benefits. AMA Guides, supra, § 1.1, at 1. The AMA Guides set forth impairment criteria that certified rating physicians and chiropractors are able to use to evaluate injured workers and give them an [i]mpairment percentage[ ] or rating[ ]. Id. § 1.2, at 4. Impairment ratings reflect functional limitation, rather than disability, and demonstrate the severity of the medical condition and the degree to which the impairment decreases an individual's ability to perform common activities of daily living. Id. Activities of daily living do not include work activities, and instead consist of everyday activities such as: self-care, personal hygiene, communication, physical activity (sitting, standing, walking, reclining, climbing stairs), sensory function (taste, smell, tactile feeling, sight, hearing), nonspecialized hand activity (grasping, lifting, tactile discrimination), travel (riding, driving, flying), sexual function, and sleep. Id. To evaluate the severity that a person's injury has on activities of daily living, a physician applies his or her knowledge of the patient's medical condition and clinical judgment. Id. § 1.2, at 5. Once the rating physician or chiropractor determines the impairment rating, then the insurance provider considers the impairment rating in conjunction with other factors, such as the worker's age, education, and previous experience, to establish disability. See id. § 1.2, at 8; NRS 616C.490(2). Chapter 15 of the fifth edition of the AMA Guides, governing injuries of the spine, is most frequently used for impairment evaluations. See Steven Babitsky & James J. Mangraviti, Jr., Understanding the AMA Guides in Workers' Compensation § 4.05 (4th ed. 2008) ( Understanding the AMA Guides ). Under the more utilized of the two methods for determining spinal impairment ratings, [2] there are different categories of spine impairments. AMA Guides, supra, § 15.4, at 384. Distinguishable from the fourth edition of the AMA Guides, the fifth edition provides that an impairment rating for each category can be adjusted up to three percent to account for treatment results and their impact on a person's ability to complete activities of daily living. See Understanding the AMA Guides, supra, § 4.02(E); see AMA Guides, supra, § 15.4, at 384. Notably, to award the additional range of up to 3 percent, objective medical evidence must establish that a permanent physical impairment exists. Understanding the AMA Guides, supra, § 4.05(C). Physicians are instructed that [a] complaint of continuing pain does not in itself justify increasing the rating because this is expected with spinal injuries. Id. Nevada statutes and regulations concerning the fifth edition of the AMA Guides In 2003, the Legislature mandated that the DIR adopt regulations that incorporate the fifth edition of the AMA Guides by reference (Nevada was previously operating under the fourth edition). See 2003 Nev. Stat., ch. 305, § 7, at 1671. The Legislature also granted DIR authority to amend its regulations after it adopted the AMA Guides, subject to certain limitations. Id. at 1671-72. DIR's amendments (a) [m]ust be consistent with the ... [AMA Guides ] ...; (b) [m]ust not incorporate any contradictory matter from any other edition of the [AMA Guides ]; and, (c) [m]ust not consider any factors other than the degree of physical impairment of the whole man in calculating the entitlement to compensation. Id.; NRS 616C.110(2). Similarly, NRS 616C.490(5), governing permanent partial disability compensation, echoes NRS 616C.110(2)(c) and provides: Unless the regulations adopted pursuant to NRS 616C.110 provide otherwise, a rating evaluation must include an evaluation of the loss of motion, sensation and strength of an injured employee if the injury is of a type that might have caused such a loss. No factors other than the degree of physical impairment of the whole man may be considered in calculating the entitlement to compensation for a permanent partial disability. (Emphasis added.) Pursuant to the Legislature's 2003 mandate, DIR adopted the fifth edition of the AMA Guides. NAC 616C.002(1). DIR also adopted NAC 616C.476, which reiterates NRS 616C.110(2)(c)'s and NRS 616C.490(5)'s prohibition on considering anything other than physical impairment: 1. A rating physician or chiropractor who performs an evaluation of a permanent partial disability shall evaluate the industrial injury or occupational disease of the injured employee as it exists at the time of the rating evaluation. The rating physician or chiropractor shall take into account any improvement or worsening of the industrial injury or occupational disease that has resulted from treatment of the industrial injury or occupational disease. The rating physician or chiropractor shall not consider any factor other than the degree of physical impairment of the whole man in calculating the entitlement to compensation. 2. In performing an evaluation of a permanent partial disability, a rating physician or chiropractor shall not use: (a) Chapter 14, Mental and Behavioral Disorders, of the Guide; or (b) Chapter 18, Pain, of the Guide. (Emphases added.) Thus, in determining the percentage of impairment in an evaluation of a permanent partial disability, rating physicians and chiropractors are only prohibited from using the chapters on mental and behavioral disorders and pain.