The 2005 Schedule for Rating Permanent Disabilities

Saturday, October 9, 2004 | 0

PD Rating Specialist, Luis Perez-Cordero, says, "Using the AMA Guides with our current evaluation procedures for the last 6-months serves as my foundation for the following exploratory overview. Wondrous things are what we should expect from the new Schedule." Here is his take on the AMA Guides as applicable to California workers' compensation permanent disability rating and benefits:

SB 899 changes after 1/1/2005:

* AMA Guidelines will be the principal resource for impairment evaluations via the P&S/MMI report. Look at the AMA Guides as a replacement for many of the California Code of Regulations dealing with the anatomic/clinical impairment.

* Schedule - LC 4660(b)(1): New Disability numbers/standards incorporating descriptions, measurements and percentages of impairment. Be aware that The Schedule has always been a concise, better-organized document for impairment percentages before modification. The Scheduled Rating Standards' underpinnings are the impairment percentages of past AMA Guides abiding to Labor Code requirements, i.e., LC 4662.

The Schedule takes the fragmented-by-Chapter impairment evaluation for the same body parts and concisely develops an impairment/disability sequence from 0-100 via Disability Numbers & Rating Standards, which are correlated to Schedule Work Capacity Guidelines (Work Capacity Functional Loss).

The AMA Guides provides different evaluation methods with specific rules in how to combine them. For the lower extremities, the AMA Guides provides impairment percentages for (1) a specific joint, (2) the entire lower extremity (regional), and (3) the whole person. To abide to the California Labor Code & SB 899's new LC 4664 (c)(1)&(2) the evaluating physician should provide both a specific area and/or regional percentages. The Spine/Torso and Lower Extremity Guides are synonymous with the AMA Guides whole person impairment percentage.

* LC 4664 (c) (1): The accumulation of all permanent disability awards issued with respect to any one region of the body in favor of one individual employee shall not exceed 100 percent over the employee's lifetime unless the employee's injury or illness is conclusively presumed to be total in character pursuant to Section 4662. As used in this section, the regions of the body are the following - A. Hearing. / B. Vision. / C. Mental and behavioral disorders. / D. The Spine. / E. The Upper Extremities including the Shoulders. / F. The Lower Extremities Including the Hips. G. The head, face, cardiovascular system, respiratory system, and all other systems or regions of the body not listed in subparagraphs (A) to (F), inclusive.

Likely Changes

AMA Guides emphasize objective anatomic factors and clinical evidence. Subjective factors are not enough to support impairment beyond a 03% level. They can no longer be the only support for any work capacity functional loss (work restrictions). With their emphasis on objectivity, the AMA Guides resemble the pre-July 1978 Schedule - the Schedule prior to the adoption of the '8 Work Functions' for Psychiatric Disabilities.

Emphasizing the objective rating of impairment, the new schedule could incorporate the following changes:

* Rounding of unmodified ratings standards of disability will return to whole numbers in increments of 1% (not 05% after 15%).

* Brain & Nervous System / Mental & Behavioral Disorders (AMA Chapters 13 &14):
Elimination of the 8 Work Functions. A Return to the Old 'Neurosis' Rating Standards emphasizing that 25% also represents the inability to operate machinery or a motor vehicle, and requires informing the Department of Motor Vehicles.
Adding Very Slight Post Traumatic Stress Syndrome - 10% Standard.
Clarification that 'Headaches' Rating Standards were primarily meant for Migraines.

* Vision (AMA Chapter 12)
As per AMA Guides, increase in disability standard for the loss of sight in one-eye to 50%, including the adoption of the new Functional Vision Score (FVS). On this scale, correctable reduction of vision to 20/200 is rated at 50%.

* Hearing (AMA Chapter 11 - Ear, Nose, Throat, and Related Structures)
Removal of hearing aid adjustment. New Value for Tinnitus - 05%.
New Disability levels for Cosmetic Disfigurement/Facial Disorders for values between 5-20% and 20-50%. New values for Respiration properly coordinated with the Respirator System Impairment (AMA-Chapter 5). Mastication, Deglutation & TMJ - New rating values beyond 30%. New values for Voice & Speech Impairment. Adjustment of Values for the loss of Smell & Taste.

* Skin (AMA Chapter 08) Changes to current rating standards to reflect multiple ratings standards.

* Upper Extremities (AMA Chapter 16)
New weighted value for abnormal motion determinations - includes shoulder motions previously not considered. Elimination of the concept of Major/Minor for a single extremity (If the disability is related to the Brain & Nervous System, see AMA Chapter 13). When determining a joint or regional impairment of disability, the evaluating physician will now consider impairment due to peripheral nerve disorders, vascular disorders, Bone & Joint Deformities. Devaluation of Grip/Strength Impairment - In the presence of decreased motion, painful conditions, deformities or amputations that prevent effective application of maximal force in the region being evaluated. Grip loss is never to be combined with motion loss.

* Lower Extremities (AMA Chapter 17)
The AMA multiple approaches to impairment determination are very similar to current scheduled disabilities with the proviso that if multiple factors are present i.e., thigh atrophy and knee motion loss, only the highest is used.
Adjustment of the Lower Extremity Guidelines with a 40% representing a 100% loss of weight bearing ability. When supported by substantial impairment & loss of function, after 40% use the Spine/Torso Guidelines - Limitation To Light Work, Semi-Sedentary & Sedentary Work.

* Abdomen/Cardiovascular/Lungs/Rib Cage/Spine (AMA Chapters 3,4,5,6 & 15)
New Spine/Torso Guidelines: Selective Semi-Sedentary Work (75%); Shelter Employment / Selective Sedentary Work (85%). Rating Standards for abnormal impairment of motion of the 3 spinal regions: Cervical Thoracic and Lumbar. New Ratings for Digestive System Disorders.

* Internal Organs & Systems: (AMA Chapters 07, 09 & 10)
New Rating Standards for Urinary Tract Impairment, including Bladder Disease, The Hematopoietic System & The Endocrine System.

DEU will be providing a general review of the amended Schedule at the DWC educational conference next year. An introduction to the AMA Guides is also being presented co-jointly by the DWC, CHSWC and CMA in both Northern California and Southern California. The first training is scheduled to take place Nov. 4-5, 2004 at the Anaheim Convention Center and the second training Nov. 8-9, 2004 at the South San Francisco Conference Center. Information about the AMA training is available at CHSWC's home page at www.dir.ca.gov/chswc, by calling (415) 703-4220, or by emailing chswc@dir.ca.gov.

Article by Luis Perez-Cordero, MA, AAPMR. http://www.pdratings.com/ .

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