Case Exercises from Guides Sixth Impairment Training Workbook–Spine

Abstract

Abstract Studying case exercises is an effective way to increase understanding of appropriate applications of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). This Case Exercise is one of more than seventy cases that are included in the new edition of the AMA Guides Casebook, and illustrates the process of assessing impairment for a mental and behavioral disorder using the fourth, fifth, and sixth editions of the AMA Guides. The patient is a fifty-year-old man who has worked twenty years at a high-end stationery and writing supply company. After a severe on-the-job back injury kept him from work for six months, he returned to work part-time but struggled with fatigue, depressed mood, irritability, and difficulty with concentration; he also reported financial and marital problems and was diagnosed with depression. Two years after the onset of depression, the patient reports feeling less depressed but also tense and anxious, particularly when tired. He is working 32 hours per week. According to the AMA Guides, Fourth Edition, the patient is rated Class 2, mild impairment, after a consideration of the patient's activities of daily living, social functioning, concentration, persistence and pace, and adaptation. Use of the fifth edition similarly results in Class 2, mild impairment. The AMA Guides, Sixth Edition, bases the rating on three psychological impairment rating scales and provides a numeric rating of 5% whole person impairment.