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Evaluating Impairment and Disability
By Scott Masterson, M.D., FAADEP, CIME
Division of Physical Medicine and Rehabilitation
In the course of a physician’s day-to-day practice, he or she will come into contact with people who have sustained various injuries and contracted any of a number of illnesses. Most of these will be acute, self-limited disorders that leave no permanent scars. Some disorders, however, will be chronic and cause long-lasting changes in that person’s life.
In many of these situations, the physician is asked to determine the individual’s level of impairment or disability. This can be a daunting task given the fact that the majority of physicians in this country have no formal training in assessing impairment and disability.The first step in improving assessment skills is defining and differentiating the terms impairment and disability. The terms are not interchangeable. Impairment does not equal disability.
Impairment
Impairment is defined as “the loss of use of, or a derangement of any body part, system, or function.” It is an objective, and therefore measurable, decrement in one’s health status. Only a physician can determine impairment ratings.
The most commonly used text for impairment ratings is the AMA Guide to the Evaluation of Permanent Impairment. Its use is required or recommended in the majority of state jurisdictions, especially in Worker’s Compensation cases. In the Guide, various tables help the physician determine a numerical loss as a percentage of the “whole person.” Where available, scientifically derived data are used to establish the “normal” function of a given organ system. If these data are not available, then “normal” has been established by a combination of the clinical experience and judgment of a consensus of contributing physicians. The Guide was first published in 1971 and is currently in its fifth edition.
Disability
Disability is defined as the “limiting loss of the capacity to meet personal, social, or occupational demands, or to meet statutory or regulatory requirements.” It is an administrative term that factors in not only health status, but also non-medical issues such as age, occupational history, and education. Most physicians do not have the necessary training to determine the relative weight of these non-medical issues, and their role is usually limited to determining medical impairment. A physician may be asked, however, to define the functional losses or functional reserve capacities associated with a particular impairment. Most commonly, long-term disability insurers and the Social Security Administration request this information.
Challenges
Unfortunately, the real world implementation of the process of determining impairment and disability are not without difficulty. Here are just a few examples:
- Impairment ratings should be objective determinations but can be influenced by a physician’s subjective interpretation of the Guide. This is especially true when attempting to factor pain complaints into the rating.
- In many jurisdictions, the onus of disability determination is placed squarely on the shoulders of physicians, even if that physician does not have the necessary skills to establish disability.
- The impairment rating should never be used to directly determine disability or directly award financial compensation. Nonetheless, many non-medical personnel do misuse impairment ratings in this fashion.
Conclusion
If you are in need of an impairment rating or disability determination, then I recommend contacting a physician who specializes in impairment and disability. Appropriate physicians in your area can be found through the American Academy of Disability Evaluating Physicians (AADEP).
Dr. Masterson is board certified in Physiatry, with a sub-specialty in Pain Management. He is a Certified Independent Medical Examiner and a Fellow of the American Academy of Disability Evaluating Physicians.
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