Effects of Treatment

Saturday, July 14, 2007 | 0

The Guides offer the following discussion for this impairment rating (5th ed., 20):

* In certain instances, the treatment of an illness may result in apparently total remission of the person's signs and symptoms. Examples include the treatment of hypothyroidism with levothyroxine and the treatment of type 1 diabetes mellitus with insulin. Yet it is debatable whether, with treatment, the patient has actually regained the previous status of normal good health. In these instances, the physician may choose to increase the impairment estimate by a small percentage (e.g., 1% to 3%).

How often is this adjustment appropriate?

Very rarely. This adjustment was designed primarily for internal medicine cases, yet 95% of all impairment ratings are musculoskeletal.

When do you recall last reviewing a report where there was an impairment rating for endocrine disease?

Prior to the use of the AMA Guides in California we do not recall reviewing any cases in which this adjustment was made, and we review thousands of cases per year. However, recently we have seen many cases where physicians have been encouraged by applicant attorneys to apply this adjustment.

What are the requirements for applying this adjustment?

* First, the examinee needs to be asymptomatic and without objective findings as a result of medications or treatment program (i.e. "total remission of the person's signs and symptoms").

* Second, if treatment was discontinued, to a reasonable degree of medical certainty the examinee would manifest signs or symptoms.

* Third, ongoing (i.e., permanent) treatment is required. For example, the use analgesics or non-steroidal anti-inflammatory agents would not meet this definition.

Why?

Typically examinees are not totally asymptomatic, they may still manifest findings, and it is doubtful the use of the medications will be lifetime in duration. If applied the physician should explain the rationale and why a specific impairment (1%, 2% or 3% was selected.) Increasing ratings for "Effects of Treatment" may suggest a rating performed by a physician inexperienced in the use of the Guides and/or biased.

Due to these types of errors all impairment ratings should be reviewed by an expert with several years experience in the use of the Guides.

To view more of these tips visit:

www.impairment.com/tips

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