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Replying to Thread: Another AMA Rating / Apportionment Question
Created On Wednesday 3, September, 2008 8:53 AM by theAxe


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theAxe
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Posts: 75
Joined: Mar 2005

Wednesday September 03, 2008 8:53 AM

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Scenario:
1. Rt. knee injury degenerative joint disease secondary to 10 year CT heavy work and natural progression results in extension lag of 10 degrees rating 8% whole person inpairment.
2. Same right knee has specific injury falling, very recent but P&S, resulting in moderate ACL laxity rating 7% whole person impairment.

QME evaluation is done...
AMA Guides state ROM and diagnosis rating cannot be combined, and doctor must choose the highest rating; resulting in doctor only rating the DJD range of motion deficit.

Problem:
Recent case law states doc must apportion disability to each injury separately, and accordingly doctor apportions the disability between the CT and natural progression - he cannot apportion any of the AMA rating based disability to the specific, as it was not a sigificant part of the degenerative disability, even though the ACL laxity definately contributes to the patient's right knee condition and disability.

Additionally noted is that even though the degenerative impairment is greater, the CT is denied and there is apportionment to non-industrial causes, while the slightly lower rated ACL laxity impairment is a clear result of the accepted specific injury.

What do the AMA Experts here think the doc should do that appropriately addresses this conundrum?



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theAxe

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Bravo
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Posts: 278
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Monday September 22, 2008 5:04 PM

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One - decide if you accept that there is an industrial CT injury medically and state why.

Two- For the CT which is P&S first, consider disability and impairment separate from the specific considering apportionment to non industrial factors.

Three- Consider PD/impairment just for the specific apportioning appropriately to prior CT disability and other non industrial causes.

You state ROM and DBE cannot be combined, but you need to consider that the CT and specific each occur in time and each probably produced some unique impairment, so the reference is for one injury they should not be combined.




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kkingdon@kingdonrating.net
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Posts: 42
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Tuesday September 23, 2008 5:42 AM

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The occurance of the impairments on different dates may not prevent application of the duplication principal.
Table 17-2 codifies methods the Guides considers duplication.
The pdrs refers to duplication of impairments of the same body part. You might be able to reasonably argue that the ligament is one body part and whatever part of the knee is degenerating is the other body part, but the knee joint itself might be considered the body part.
Also, you can combine arthritis in the knee with DBE, and it sounds as if that might be occurring here.

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