Two years into use of the AMA Guides we are beginning to notice some common ways physicians are erroneously inflating ratings.  The most prevalent violation is the misapplication of grip loss.  Strength loss, which includes grip loss, is given very little weight by the Guides, reserved for rare cases (muscle tears, tendon ruptures, post surgical epicondylitis).  Also, page 508 of the Guides states “decreased strength cannot be rated in the presence of decreased motion”.  Further, page 494 states “In compression neuropathies (carpal tunnel syndrome), additional impairment values are not given for decreased grip strength”.  Unfortunately, a significant number of physicians are unaware of these rules.  Remember, if you come across a strength loss rating, especially in the presence of decreased motion or carpal tunnel syndrome, the impairment is probably not valid. 

Moving to the Central Nervous System chapter (chapter 13), we find physicians assigning impairment due to Sleep Disorders (table 13-4) based on applicant’s complaints of sleeplessness as a result of orthopaedic injuries.  However, page 317 of the Guides indicates this diagnosis must be supported by formal studies in a sleep lab.  I have yet to see an applicant actually complete such a study.

Phil Walker, Northern California attorney and expert on the Guides, provides an excellent discussion on these topics.  As examiners, be aware of these inflation techniques and the citations you can use to refute them.  As always, we are available for all your rating needs.

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