module 7 part 4

Question 1

How are multiple impairments rated?

Answer 1

Convert each to WPI, combine with the Combined Values Chart (CVC), then adjust for DFEC, age, and occupation.

Question 2

Mnemonic for multiple impairment steps

Answer 2

“C-WAD” — Combine WPI, Adjust DFEC/Age/Occupation, Done.

Question 3

Why must QME describe objective findings?

Answer 3

Objective deficits are required by AMA Guides; subjective complaints alone cannot support WPI.

Question 4

What if an impairment doesn’t match AMA chapter?

Answer 4

QME may use Almaraz/Guzman to justify alternate chapter or method with clear rationale.

Question 5

Can WPI be 0% if patient has symptoms?

Answer 5

Yes — if no objective impairment is found or symptoms don’t meet AMA criteria.

Question 6

What is the pain add-on limit again?

Answer 6

Up to 3% WPI maximum per Guides when pain adds measurable functional loss.

Question 7

Why must QME describe ROM (Range of Motion)?

Answer 7

ROM loss is key metric in many body part ratings under AMA Guides.

Question 8

Mnemonic for ROM rating

Answer 8

“MOTION → %.”

Question 9

How is spinal impairment usually rated?

Answer 9

By DRE (Diagnosis-Related Estimates) or ROM method if DRE doesn’t fit; must document which method used.

Question 10

What is DRE category system?

Answer 10

5 categories (I–V) for spinal injuries, each with defined impairment % ranges.

Question 11

Mnemonic for DRE

Answer 11

“I Mild → V Severe.”

Question 12

Can QME switch from DRE to ROM?

Answer 12

Yes, if DRE doesn’t fit; must justify using Almaraz/Guzman reasoning.

Question 13

Why document neurologic deficits?

Answer 13

Radiculopathy or nerve injury can increase WPI and change rating category.

Question 14

How to rate amputations?

Answer 14

Use AMA tables for specific level; convert regional impairment to WPI, then to PD.

Question 15

Mnemonic for amputation

Answer 15

“Level → % → WPI → PD.”

Question 16

What is ankylosis rating?

Answer 16

Fusion/stiff joint is rated using specific AMA impairment tables for that joint.

Question 17

Why include surgical history in rating?

Answer 17

Surgical changes (fusion, prosthetics) alter impairment level and may increase WPI.

Question 18

What is assistive device adjustment?

Answer 18

Use of braces, canes, etc. can increase impairment if medically necessary and permanent.

Question 19

Mnemonic for device impact

Answer 19

“ADDS” — Assistive Device = Disability Shift.

Question 20

What is Combined Values Chart (CVC) key rule?

Answer 20

Combine, don’t add; prevents exceeding 100% and reflects overlapping functional loss.

Question 21

Can WPI exceed 100%?

Answer 21

No — maximum whole person impairment is 100%.

Question 22

Why note dominance (right vs left hand)?

Answer 22

Dominant hand impairment often rated higher due to greater functional impact.

Question 23

How to handle multiple surgeries on one body part?

Answer 23

Rate final impairment considering all residuals; don’t rate each surgery separately.

Question 24

Why use exact AMA table numbers?

Answer 24

Allows DEU/judges to verify rating and avoids disputes about methodology.

Question 25

What if Guides don’t cover a condition?

Answer 25

QME may use analogy to similar body part/function with explanation and literature support.

Question 26

Mnemonic for unsupported condition

Answer 26

“ANA” — Analogize, Note rationale, Apply % carefully.

Question 27

How can QME defend rating in deposition?

Answer 27

Cite AMA Guides pages, show objective findings, and explain each adjustment step clearly.