AMA Guidelines and Workers’ Comp

Often time’s victims of work place injuries are required to attend an FCE (Functional Capacity Evaluation – see previous blog post for more info on FCEs) to determine their permanent restrictions after they have recovered from an injury. The Virginia Workers’ Compensation Commission requires examiners to use the AMA Guidelines as a way to standardize test results and minimize inconsistencies.

Virginia uses the 6^th Edition of the AMA Guidelines for rating a person’s impairment level and permanent restrictions. Needless to say, I am not a fan of the 6^th Editions guidelines for several reasons:

1) The term “disability” is redefined in the Sixth Edition. Disability is defined as “activity limitations and/or participation restrictions in an individual with a health condition disorder or disease.” This is a significant change from Fifth Edition’s definition of disability as “alteration of an individual’s capacity to meet personal, social or occupational demands or statutory or regulatory requirements because of impairment.”

2) Impairment values have been lowered in the Sixth Edition. Impairment is redefined as “significant deviation, loss, or loss of use of any body structure or body function in an individual with a health condition, disorder or disease.” The Sixth Edition adds the word “significant” to the definition. Examples of rating reductions in the Sixth Edition include the following:

Distal biceps tendon rupture, Sixth Edition impairment (WPI %): 4%, Fifth Edition impairment (WPI %): 6%

Total ankle replacement with poor result, Sixth Edition impairment (WPI %) 24%, Fifth Edition impairment (WPI %) 30%

Total knee replacement, Sixth Edition impairment (WPI %) 15%, Fifth Edition impairment (WPI %) 20%

Hip fracture, Sixth Edition impairment (WPI %) 12%, Fifth Edition impairment (WPI %) 25%

3) The Sixth Edition takes away range of motion model for ratings. There are two systems for rating impairment in the Fifth Edition: the diagnostic related estimate (DRE) and the range of motion model (ROM). Functional factors like strength, endurance, and coordination are more individualized, and the ROM considers these factors and DRE does not.

4) The Sixth Edition takes away pain as a factor in impairment ratings

Perhaps the most egregious take-away in the Sixth Edition is the further deprecation of pain as a factor in impairment ratings. The pain add-ons in the Fifth Edition are no longer permitted in the Sixth Edition.

5) The Sixth Edition forces individuals into specific categories.

The demand that all impairment be verified by objective findings is at odds with realistic understanding of how injuries disable people. Apart from a few conditions-such as loss of limb, blindness or a coma – most injuries do not prevent people from working due to mechanical failure. Rather, a worker is disabled by a variety of unbearable sensations attempting to work. It is called the “5gh vital sign,” or pain

6) ADL scales are not adequately accounted for in the Sixth Edition.

Functional losses, in terms of ADLs, are simply not manifest in the impairment ratings.

The bottom-line is that the 6th Edition hurts my clients’ workers comp benefits with these inappropriate calculations.