This document will provide you with an express introduction to creating an impairment rating report based on the 6th edition of the AMA Guides. In the first section, you'll read about the patient's history and condition as documented by the examiner. Then you'll see the steps used to create the report with ImpairMaster.


Case Documentation

Patient name: Mr. Patient

Patient age: 44

Dexterity:  Right handed

Examiner:  Dr. Examiner


History

Patient sustained a blow to the posterior aspect of his neck from a machine support that slipped. Studies revealed a C7-T1 disk herniation. He was managed conservatively, and in spite of persistent symptoms, refused surgery. He was evaluated for impairment one year after his injury.


Current Symptoms

Patient reports neck pain with radiation to the ulnar aspect of the hand and numbness of the ring and little fingers. He is unable to use his dominant left hand for activities for daily living (ADLs) without considerable pain in the neck, left upper back, and ulnar side of the left upper limb, with minimal activity.


Functional Assessment

PDQ score is 120, consistent with severe disability (pain disability questionnaire)


Physical Exam

  • Decreased range of motion in the neck
  • Positive cervical compression with severe radiating pain to the left arm in a C8 distribution
  • Decreased finger flexion strength
  • Decreased sensation in ring and little fingers
  • MRI: left posterolateral disk herniation C7-T1
  • EMG: left C8 fibrillation potentials


Clinical Tests

  • MRI: left posterolateral disk herniation C7-T1
  • EMG: left C8 fibrillation potentials


Diagnosis

Cervical disk herniation with C8 radiculopathy


Using ImpairMaster


After you log into ImpairMaster, you'll see the Report Manager, a place where you'll be able to create and manage your reports.



The Report Manager shows you the last several reports you worked on. It gives you the ability to:

  • Create a new impairment rating report by clicking the green Create New Report button.
  • Delete previously created reports by clicking the red Delete button.
  • Change details about the patient, examiner, and examination by clicking the white Settings button.
  • Make changes to an existing report by clicking on the row for the report you want to change (e.g., click on the patient's name).
  • Search for previously created reports by typing part of a subject name or reference in the search field, then clicking the blue Search button.
  • Make changes to your user profile and manage your subscription by clicking on your user name in the upper right corner.
  • View ImpairMaster documentation or get support by clicking on the Help link.


Creating a new report

  1. Click the green Create New Report button. After clicking the button, the Report Settings form will be displayed.
  2. In the Report Settings form:
    • Provide the subject's name:  Johann S. Bach
    • Provide the subject's age:  50
    • Select the subject's dexterity:  Right handed
    • Provide the evaluator's name: Enter your name
    • Verify the date of exam.
    • The reference field is optional and can be anything you like. For example, it can be the patient's chart number or the treating physician's name.
    • For now, leave the functional history calculation settings at its default setting, "Include highest only".
  3. Click the Save button.

After clicking the save button, you will be taken to the Report Editor.


Add the impairment to the report


In this section, you'll add the impairment for the disk herniation to the report. The first few steps help to hone in on the correct condition.


  1. Click the blue +Impairment button.

  2. Since the diagnosis indicates a condition in the cervical spine, click on: Spine & Pelvis

  3. From the list of areas under the Spine & Pelvis, click on: Cervical Spine

    After you click the Cervical Spine, you'll see a list of conditions from the Cervical Spine Regional Grid. The diagnosis that most closely matches the patient's diagnosis of cervical disk herniation with C8 radiculopathy is "Intervertebral disc herniation and/or AOMSI.

  4. Click on: Intervertebral disc herniation and/or AOMSI
  5. At this point, you've identified the "key factor", or in this case, the History of Clinical Presentation. Now you must select the appropriate class (severity) and apply as many non-key factors as necessary. In the diagnosis editor (shown below), click on the various severity classes to see the difference in their descriptions. Since the subject's diagnosis is "Cervical disk herniation with C8 radiculopathy", Class 2 should be selected since its description indicates "Intervertebral disk herniation" as well as "... with documented residual radiculopathy." Notice that Class 2 represents 11% whole person (outlined in red).

  6. With the class selected, you can now account for the non-key factors of functional history, physical examination and clinical studies. As indicated earlier in this tutorial, the subject's PDQ score is 120. To account for this, in the Non-key factors section, under the functional history tab, click: PDQ or alternative validated functional assessment, scaled appropriately.

  7. A pop-up window will appear so you can select the grade that corresponds to the PDQ score of 120. In this case, click the radio button for Grade 3 - Severe disability; PDQ score of 101 to 130, then click the Save button.

    Notice that the impairment is now 12% whole person (it was 11% before applying the PDQ grade modifier). Now you'll repeat this process to account for physical examination grade modifiers.

  8. The physical examination found a positive cervical compression with severe radiating pain to the left arm in a C8 distribution.
    • Click on the physical examination tab
    • Click on Cervical compression/foraminal compression
    • Select Grade 2 - Positive cervical compression/foraminal compression (Spurling's test) with reproducible radicular pain
    • Click the Save button
  9. The physical examination indicated decreased finger flexion strength (3/5).
    • Click on Motor deficit
    • Select Grade 2 - Active movement against gravity only, without resistance (3/5)
    • Click the Save button
  10. The physical examination indicated decreased sensation in ring and little fingers.
    • Click on Sensory deficit
    • Select Grade 2 - Diminished light touch (with some abnormal sensations or slight pain) in a clinically appropriate distribution, that interferes with some activities
    • Click the Save button
  11. Finally, clinical tests included an MRI which revealed a left posterolateral disk herniation C7-T1
    • Click on the clinical studies tab
    • Click on Imaging studies: Radiographs, bone scan, MRI
    • Select Grade 2 - CT/MRI/other imaging findings consistent with clinical presentation, including evidence of AOMSI with segmental instability, fusion, or motion preservation device defined by region
    • Click the Save button.

      Your impairment editor should resemble the one shown below:
  12. Click Save and finish. ImpairMaster will calculate the impairment for this condition.


When the report view is displayed, you can see how ImpairMaster accounted for the diagnosis (key factor), the supplied non-key factors, and provided all of the calculations with cross-references to the 6th edition of the Guides.


How to explain this report

  • This report evaluates an intervertebral disc herniation and/oir AOMSI. It contains only a single impairment.
  • The first paragraph identifies the key factor, in this case, the History of Clinical Presentation. It includes cross-references to the Guides so you can quickly find the tables where the applicable classification grid can be found. Table 17-2 shows that Class 2 of Intervertebral disc herniation and/or AOMSI has impairment range of 9% to 14%, spread out as Grade A=9%, Grade B=10%, Grade C=11%, Grade D=12%, and Grade E=14%. The middle value 11%, is identified as the default impairment.
  • The 2nd through 6th paragraphs identify the various grade modifiers from the functional history, physical examination, and clinical studies adjustment grids. ImpairMaster will select the HIGHEST grade modifier from each of the adjustment grids for use in the final calculation table.
  • The calculation table shows the formula used to determine the net adjustment.
    The net adjustment is used to move the impairment value either higher (to Grade D or Grade E) or lower (to Grade A or Grade B). Remember, the default impairment is Grade C, 11%. A net adjustment of +1 will move up one notch to Grade D (12%). A net adjustment of -2 will move the impairment down two notches to Grade A (9%). For this report, the net adjustment is +1, therefore, the final impairment will be Grade D, 12%.
    • CDX refers to the diagnosis class (severity). In this example, the class was specified as Class 2.
    • GMFH refers to the Functional History Grade Modifier. In this example, the highest GMFH was grade 3.
    • GMPE refers to the Physical Examination Grade Modifier. In this example, the highest GMPE was grade 2.
    • GMCS refers to the Clinical Studies Grade Modifier. In this example, the highest GMCS was grade 2.
    • By applying the formula (GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX), you get (3-2)+(2-2)+(2-2) = +1.