Impairment Rating and Disability Evaluation.

Impairment Rating and Disability Evaluation

Rondinelli RD, Katz RT, eds. Philadelphia, PA 19106, WB Saunders Co, 2000, hardcover, 344 pp, illus, ISBN: 0-7216-7772-X, $59.

The purpose of this book is to provide an overview of the concepts and models of disablement and the major US and Canadian disability systems. Particular attention is paid to the definitions of impairment and disability and how physicians, therapists, and other health care providers may assess these 2 aspects of rehabilitation medicine.

The book is divided into 4 sections: "Conceptual Overview," "Assessment Tools for Rating Musculoskeletal Impairment and Work Disability," "Impairment Rating and Disability Evaluations for the Major U.S. and Canadian Disability Systems," and "Physician Disability Practice Applications."

The first section, "Conceptual Overview," reviews the origins and historical backgrounds of the major US disability and compensation systems. The conceptual framework and working definitions used for assessing impairment and disability are presented in this section. The evolution of the disablement models used in the United States is reviewed and discussed in chapter 2. Chapter 2 also presents major criticisms of the existing models and, in particular, of the overemphasis on the "medical model" by the American Medical Association's Guides to the Evaluation of Permanent Impairment, 4th edition. The authors propose that any comprehensive disability assessment must consider environmental factors and the cognitive, emotional, and motivational factors of the affected individual as well as those medical issues addressed by the AMA Guides.

Chapter 3 contains an overview of basic criteria of measurement adequacy. The items of interest include examination of the 4 possible levels of measurement (ie, nominal, ordinal, interval, ratio) and criteria of adequacy (ie, reliability, validity, precision, range, feasibility, practicality) as well as the relevance of measurement. The information presented in chapter 3 may be used to critically evaluate available tests and measures used for impairment assessments and disability determinations.

Section 2, "Assessment Tools for Rating Musculoskeletal Impairment and Work Disability," is filled with useful information, and it is well written and richly referenced. It contains information that clarifies the application and limitations of physical tools and tests that are readily available to assess musculoskeletal impairment, functional capacity, and the psychological, social, and behavioral aspects of patients with musculoskeletal complaints. The last chapter in this section, "Physician Assessment of Working Capacity," brings together information found in the preceding 3 chapters by providing the rationale and format for the health care provider to make work capacity determinations.

Section 3 summarizes the United States Workers' Compensation system, the Social Security Disability Insurance and Supplemental Security Income system, the Disability Evaluation under the Department of Veterans Affairs, and the Canadian Disability System. The purpose of this section is to help health care providers understand the various systems, understand what type of objective medical evidence is needed to document disability, and define what other parameters may be included in assessing an individual's ability to work. Moreover, it explains the administrative options open to individuals who may have applied for and been denied benefits. This section contains many useful figures, tables, sample forms, sample examination reports, references, and case scenarios.

The final section of the book, "Physician Disability Practice Applications," begins by defining the role of the independent (impartial) medical evaluation (IME) physician. The reasons for performing an IME and elements of the IME report are contained in chapter 12. This chapter is especially well written and provides a concise explanation of the IME physician's role. In chapter 13, "Disability Evaluation and Unexplained Pain," the authors provide definitions and classifications of pain. The chapter also discusses issues related to estimating pain impairment and recognizing psychiatric conditions as confounders of pain complaints, including anxiety, depression, substance abuse disorders, somatoform disorder, undifferentiated somatoform disorder, personality disorders, antisocial personality, malingering, and pain disorder.

At first glance, chapter 14, "Life Care Planning: Using Childhood Development Disability as a Model," seems out of place in a book focused on the "worker" impairment and disability. On closer examination, however, it is clear that the author uses the life care plan of patients with cerebral palsy and mental retardation to illustrate the need for a standardized approach to determine the future costs for caring for all clients with disabilities, regardless of age, occupation, or medical diagnosis. An excellent sample of a detailed life care plan is provided in this chapter. The final chapter of the book, "Medical Testimony and the Expert Witness," contains useful legal information and practical guidelines for health care providers to use when preparing for and entering into the medicolegal area and when serving as an expert witness.

This book is well written and well organized. Impairment Rating and Disability Evaluation, along with a copy of the American Medical Association's Guides to the Evaluation of Permanent Impairment, will serve as primary references for physicians, therapists, and other health care providers confronted by requests for impairment assessments and disability determinations.

David Nestor, PT, ECS
Federal Medical Center
Lexington, Ky

CAPT Nestor is the Deputy Director of Rehabilitation Service for the Federal Bureau of Prisons.