AMA-Lower Extremities-6-14-16-wointros

42 Pages·2016·2.76 MB·English

6/14/2016
T L E
HE OWER XTREMITIES
AMA G C 17
UIDES HAPTER
Tim Mussack
Marlene Phillips
Bradford & Barthel, LLP
AMA Analysis and Ratings Division
Bradford & Barthel
AMA Analysis and Ratings Division
• Tim Mussack
[phone]
[email protected]
• Marlene Phillips
[phone]
[email protected]
• [email protected]
http://www.bradfordbarthel.com/areas-of-practice/bb-
ratings/rating-referral-form/
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Most Frequently Used Chapters
• Chapters 1 & 2 ---The ‘Constitution’
– From page 17, in the Introduction to Chapter 2, the Practical Application of
the Guides:
“Two physicians, following the methods of the Guides to evaluate the same
patient, should report similar results and reach similar conclusions.
Moreover, if the clinical findings are fully described, any knowledgeable
observer may check the findings with the Guides criteria.”
• The Almaraz Guzman en banc decision of 9/3/2009:
“…by requiring use of the AMA Guides to determine impairment, the
Legislature furthered its expressly stated goal of achieving “consistency,
uniformity, and objectivity.”
• Chapter 15 --- Spine
• Chapter 16 --- Upper Extremity (UE)
• Chapter 17 --- Lower Extremity (LE)
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The Lower Extremities
• Lower extremity impairment values
• Combining
– Impairment
– PD (after adjustment)
• Methods of Evaluation
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Chapter 17 – The Lower Extremities
there are errata
• 17.1 Principles of Assessment
(p. 524-525)
• 17.2 Methods of Assessment (p. 525-554)
• 17.3 LE Impairment Evaluation Procedure
Summary and Examples (p. 555-560)
• Impairment evaluations are performed after the
injured worker attains MMI
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‘Regional’ Impairment
• AMA Guides is not jurisdictionally specific for evaluating
Permanent Disability
• The California Schedule for Rating gives additional instructions for rating Permanent
Disabilities.
• Section 1 of the rating schedule is Introduction and Instructions.
From page 1-4:
• "The impairment number identifies the body part, organ system and/ or nature of the
injury..."
• "Under Section 2 of the Permanent Disability Rating Schedule, an appropriate impairment
number can be found for most impairments."
On page 1-5:
• "A single injury can result in multiple impairments of several parts of the body. For
example, an injury to the arm could result in limited elbow range of motion and shoulder
instability..."
On page 1-11 of the Schedule:
• "...'adjusting' refers to adjusting an AMA impairment rating for diminished future earning
capacity, occupation, and age."
• "Impairments of an individual extremity are adjusted and combined at the whole person
level with other impairments of the same extremity..."
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Impairment Values
• 100% LE = 40% WPI [LE % x .4 = WPI %]
– Table 17-3 – page 527
• 100% Foot = 70% LE [Foot % x .7 = LE %]
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Table 17-3 – page 527
Conversion Table – LE to WPI
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Combine or Add, and CVC
• Numbers that are put together for evaluation of impairment/ PD
must be either added or combined.
• When to combine:
• COMBINE –for most situations --unless specific instructions state
to ADD impairment values. The effect/ purpose of combining is
that it prevents the combined value from exceeding 100.
A + B(1 –A) [where A and B are decimal equivalents]
• When to add:
• The most notable exception to combining impairments is with the
evaluation of range of motion impairment for the same part of the
body (for example, right ankle motion) [hand evaluation has
unique methodology]
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Combine or Add, and CVC
• How to combine:
• Page 1-11 of the 2005 PDRS:
• Multiple impairments such as those involving a single part of an extremity, e.g.
two impairment involving a shoulder such as shoulder instability and limited
range of motion, are combined at the upper extremity level, then converted to
whole person impairment and adjusted before being combined with other parts
of the same extremity.
•
• Impairments with disability numbers in the 16.01 and 17.01 series are converted
to whole person impairment and adjusted before being combined with any other
impairment of the same extremity.
•
• Impairments of an individual extremity are adjusted and combined at the whole
person [PD] level with other impairments of the same extremity before being
combined with impairments of other body parts. For example, an impairment of
the left knee and ankle would be combined before further combination with an
impairment of the opposing leg or the back.
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Chapter 17
• 13 Methods of Assessment
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Methods Used to Evaluate
Impairments of the Lower Extremities
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Table 17-2, page 526
“After all potentially impairing conditions have
been identified and correct ratings recorded
…select the…most specific…method(s) and
record the estimated impairment for each.”
“explain in writing why a particular
method(s)…was chosen.”(p. 526)
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Table 17-2
• “Typically, one method will adequately
characterize the impairment…”
• “Avoid combining methods that rate the
same condition.”
• “If more than one method can be used, the
method that provides the higher rating
should be adopted.” (page 527)
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Interpolation
• When a Table gives a range for objective
findings, and a correlating range for
impairment, use interpolation to provide the
appropriate value (as shown in Example 17-
15, with leg shortening)
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Method #1
Limb Length Discrepancy
• X-rays strongly recommended
Repeat 3 times
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“averaged to reduce measurement error”
P. 528
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