Guide to the Guides - Fifth Edition

1 Guides to the Guides : Evaluator s Resource Algorithm to the AMA Guides 2014 Steven D. Feinberg, MD and Christopher R. Brigham, MD. All rights reserved. No part of this publication may be reproduced or transmitted by any means without written permission. 1 Guide to the Guides : Evaluator s Resource Algorithm to the AMA Guides to the Evaluation of Permanent Impairment, Fifth Ed. - Musculoskeletal, Nervous System and Pain Steven D. Feinberg, MD Christopher R. Brigham, MD Guides to the Guides : Evaluator s Resource Algorithm to the AMA Guides 2014 Steven D.

2 Feinberg, MD and Christopher R. Brigham, MD. All rights reserved. No part of this publication may be reproduced or transmitted by any means without written permission. 2 This book is for information purposes only. It is not intended to constitute medical, legal or financial advice. If medical, legal, financial, or other professional advice is required, the services of a competent professional should be sought. No part of this publication may be reproduced, storied in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors.

3 Guides to the Guides : Evaluator s Resource Algorithm to the AMA Guides 2014 Steven D. Feinberg, MD and Christopher R. Brigham, MD. All rights reserved. No part of this publication may be reproduced or transmitted by any means without written permission. 3 Preface This resource is designed to simplify use of the AMA Guides to the Evaluation of Permanent Impairment and improve the accuracy of ratings. The reality is that there is no easy way to learn the AMA Guides but this is an approach at perhaps making it a little simpler.

4 It is critical that you keep the AMA Guides 5th Edition available as you review this resource. We have provided you with a format such that if the examiner answers the questions and fills out the integrated fill-in squares and check off boxes, the examiner should at least identify and address all possible issues for an AMA Guides impairment evaluation. We welcome your feedback. Authors Steven Feinberg, MD Feinberg Medical Group, 825 El Camino Real, Palo Alto, CA 94301; 650-223-6400; American Board of Pain Medicine, American Board of Electrodiagnostic Medicine, American Board of Physical Medicine & Rehabilitation, Qualified Medical Evaluator, Adjunct Clinical Professor, Stanford University School of Medicine, and Medical Director of Cedaron AMA Guides Impairment Rating software.

5 Dr. Feinberg served on the ACOEM Chronic Pain Guidelines Panel Chapter Update and also as Associate Editor, as a Medical Reviewer for the ACOEM 2014 Opioid Guidelines and he also serves ongoing as a Medical Consultant to the Official Disability Guidelines (ODG) and on the Reed Group s Medical Advisory Board. He served as a Reviewer for the AMA Guides to the Evaluation of Permanent Impairment, 6th Edition . Christopher R. Brigham, MD President, Brigham and Associates, Inc., Brigham and Associates, Inc.

6 , Pali Palms Plaza, Suite C312, 970 North Kalaheo Avenue, Kailua, HI 96734, 808-254-9400; American Board of Preventive Medicine Occupational Medicine, Fellow American Academy of Disability Evaluating Physicians and Certification in Evaluation of Disability and impairment rating, Fellow American College of Occupational and Environmental Medicine, Certified Independent Medical Examiner and Founder of American Board of Independent Medical Examiners, Editor-in-chief of the AMA Guides Newsletter and Guides Casebook and was co-author of Understanding the AMA Guides in Workers Compensation.

7 He is the Senior Contributing Editor for the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition , and was a contributor/author for the musculoskeletal chapters. For the Fifth Edition , he served on the Advisory Committee and as a contributor. Guides to the Guides : Evaluator s Resource Algorithm to the AMA Guides 2014 Steven D. Feinberg, MD and Christopher R. Brigham, MD. All rights reserved. No part of this publication may be reproduced or transmitted by any means without written permission.

8 4 Table of Contents PREFACE _____ 3 AUTHORS _____ 3 TABLE OF CONTENTS _____ 4 ORIENTATION _____ 4 CHAPTER 13 THE CENTRAL AND PERIPHERAL NERVOUS _____ 6 CHAPTER 15 THE SPINE _____ 18 CHAPTER 16 THE UPPER EXTREMITIES _____ 30 CHAPTER 17 THE LOWER EXTREMITIES _____ 51 CHAPTER 18 PAIN _____ 71 INDEX _____ 73 Orientation The AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition is the standard for rating impairment. Physicians and others are trying to learn it and then apply it in a fair and equitable manner.

9 It is imperative that the physician understand and follow the principles of the Guides . Chapter 1 Philosophy, Purpose and Appropriate Use of the Guides and Chapter 2 Practical Applications of the Guides define standards that apply to all ratings. The individual chapters define principles of assessment and the rating process. Maximal Medical Improvement (MMI) or Permanent and Stationary (P&S) The examinee must be at maximal medical improvement (MMI), the equivalent of Permanent and Stationary (P&S), to produce an impairment rating.

10 It is necessary to determine that the patient is stable, and that no further restoration of function is probable. If the examinee shows up and is in the middle of a flare-up or has had a new injury that interferes with the examination, it is premature to do an impairment rating. In other words, the examinee must be stabilized medically for the physician to fairly assess the impairment rating. If the condition is changing or likely to improve substantially with medical treatment, the impairment is not permanent and should not be rated.