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Shaw Chiropractic Impairment Vs. Disability The application of impairment ratings vs disability ratings can cause both physicians and attorneys a great deal of confusion. The fundamental problem is that many attorneys and physicians assume that these two terms are synonymous. However, impairments and disabilities have very different meanings and their applications should be thoroughly understood by all parties who deal with the final outcome assessment of patients and clients. Permanent Impairment - "This is a purely medical condition. Permanent impairment is an anatomical or functional abnormality or loss after Maximal Medical Rehabilitation has been achieved, which abnormality or loss the physician considers stable or non progressive at the time of evaluation. It is always a basic consideration in the evaluation of permanent disability". To rate impairment is to rate every day bodily functions. Permanent Disability - " This is not a purely medical condition. A patient is "permanently disabled" or "under a permanent disability" when his actual or presumed ability to engage in gainful activity is reduced or absent because of "impairment" which in turn, may or may not be combined with other factors. A permanent condition is found if no fundamental or marked change can be expected in the future." To rate disability is to rate employability. What he or she can do to earn a living. Physicians should not be required to rate disability. They rate physical impairment. Attorneys, judges and vocational rehabilitation specialists rate disability. The physician's recommendations found in the final narrative report should contain the physical capabilities and limitations of the patient. This information will aid interested parties in the determination of the patient's disability. Use of the AMA Guides 1. The use of the Guides represent estimates rather then precise determinations. 2. Where objective data is available it should be used. When the physician is unable to find or use objective data, then he or she must rely on clinical experience The Guides do not provide all the answers. A physician's judgement, expertise, and skill are factors in estimating the degree of a patient's impairment. 3. A 1991 survey indicates that for 40 out of 53 jurisdictions, use the Guides is mandated or recommended by law in workers' compensation cases. 4. It must be emphasized and clearly understood that Impairment percentages derived according to the Guides should not be used to make direct financial awards or direct estimates of disabilities. The 4th Edition The 4th edition of the Guides has been changed to use two methods to evaluate spinal impairments. These include the new "Injury Model" (AKA Diagnostic Related Estimates method or DRE) and the conventional "Functional or Range of Motion Model" . Until the recent edition of the Guides the range of motion model was the preferred method. However, the DRE is now the recommended approach. Using the DRE approach the physician establishes the diagnosis, and then by using differentiators, determines the appropriate category (I-VIII) that the patient best fits into. No differentiator is required to place a patient in any category. However, if a differentiator is present, it provides important evidence as to the category in which a patient belongs. DIFFERENTIATORS: 1. Guarding Only when a patient cannot be rated by the DRE method should the ROM model be used. In the ROM model the physician uses Table 75 for Specific Spinal Disorders and combines those values with range of motion, neurological deficits and values for the organ systems involved.
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