Chapter 10 Determination of Disability Flashcards Preview

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Flashcards in Chapter 10 Determination of Disability Deck (19):

In theory, the determination of disability should be

a transparent, unprejudiced, and objective process, and impairments or functional limitations should be correlated with objective evidence for tissue damage, organ dysfunction, or cognitive dysfunction, and this evidence should be reproducible in examination or diagnostic study



is an alteration in one’s physical or cognitive
capacity to perform a specific task, function, or activity and
is highly dependent on individuality and context



is an objective term that defines the loss or loss of use or derangement of any body part, organ system or organ function, but can also relate to impairments of cognitive
or psychological functioning. Impairment may be temporary or permanent, and can be reproducibly measured through testing or physician assessment



is a legal or policy term used to describe a disability.


An impairment rating or whole person impairment

is a specific and objective
assessment of a patient’s impairment, and can be derived by using the American Medical Association’s Guides to the
Evaluation of Permanent Impairment. This rating defines the impact of an impairment on one’s ability to perform typical activities of daily living, including self-care, personal hygiene,
use of hands, ability to communicate, sensory functioning, sexual function, and ability to travel.Overall, the greater and more impactful the impairment is, the larger the whole person impairment percentage will be.


Maximal Medical Improvement (MMI)

It is important to note that an impairment rating
should not be assessed until the patient has reached maximal
medical improvement (MMI). MMI is the state at which all potential healing, repair, and treatment has been completed, and the impairment is permanent and unlikely to change
significantly within the ensuing 1-year period


The Social Security Act defines disability as

“the inability to engage in any substantial gainful activity by reason of a medically determinable physical or mental
impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of
not less than 12 months.


Four categories of disability are possible

temporary partial; temporary total;
permanent partial; permanent total—and the work-related injury
can be physical or mental


Independent Medical Evaluation (IME)

An independent medical evaluation (IME) is a comprehensive assessment of a patient by a trained physician


The purpose of the IME

is to objectively assess the impact of an injury and subsequent disability on
the patient’s ability to function in a variety of domains, including
self care, work duty, leisure, or recreational activity.


The evaluating physician

The evaluating physician reviews the treatment to date, performs a physical examination, and reviews pertinent diagnostic
tests and procedure reports, and then comments on the current clinical status, relevant diagnoses, and whether
the patient is at MMI.


The IME report

The IME report should address causation of the injury and the relationship of the injury to the impairment, and any anatomic, physiologic, or psychological impairments should be identified or described, in addition
to the permanence of these impairments.


Functional limitations

defined as a lack of ability to perform an activity
within a normal human range as the result of a specific impairment, should be specifically addressed in an IME report


Components of an Independent Medical

Narrative history
Current clinical status
Results of physical exam and diagnostic studies
Causation of injury and relationship to job
MMI assessment
Pertinent diagnoses
Impairments and function limitations
Permanence of impairments
Analysis of job tasks
Assessment of patient ability to perform job tasks


Functional capacity evaluation (FCE) or work capacity evaluation (WCE)

are measures of a patient’s functional ability and are typically performed with a physical therapist or occupational therapist. Tolerances for sitting, standing, walking, bending, reaching, lifting, and climbing are typically assessed, with a specific emphasis on the ability to lift and carry specific weights. The outcome of the evaluations is highly dependent on the
patient’s motivation and effort, and is inherently subjective to the examiner, especially in chronic pain patients



Disability and function should be addressed
early on in the doctor–patient relationship and continually reassessed when function remains limited. Management
should include an assessment of disability risk, patient education,
and psychosocial support in addition to a treatment
plan that outlines expectations for improvement.


Red flags for protracted disability

include noncompliance with treatment,
poor participation in physical therapy or rehabilitation,
refusal or inability to return to work, and noncompliance
with weight loss and exercise recommendations.


Disability syndrome

is set of dysfunctional
and counterproductive attitudes and beliefs that
develop over time as an individual adapts to the role of being a disabled person. The more significant the dysfunction in the patient, the more important the multidisciplinary approach
to pain management is necessary


Predictors of chronic pain and subsequent protracted disability

Catastrophizing, fear avoidance beliefs, and other maladaptive behaviors should be identified and addressed by the pain specialist,

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