Braddom's Physical Medicine and Rehabilitation: 5 - Practical Aspects of Impairment Rating and Disability Determination

By nature, the field of physiatry is directed toward the evaluation and treatment of medical conditions that are at once impairing to physical and/or functional performance of the affected individual, and thereby potentially disabling. The traditional focus becomes one of minimizing the impairment and the disabling consequences of disease. They physiatrist armed with this perspective and clinical experience is also ideally suited to evaluate the extent of impairment and associated disability in any particular case. Therefore this chapter is intended to provide the reader with an overview of the scope and content of physician activity directed toward the rating of physical and functional impairment arising out of illness or injury, and the physician's role in the disability determination process for the various U.S. disability systems that they may encounter in a typical physiatry practice. The topics addressed include:- Basic terminology and conceptualization of disablement- The role of the International Classification of Functioning, Disability, and Health (ICF) in unifying the terminology and classification of disablement- Relating impairment to disability compensation formulas- The major U.S. disability systems compared- Description and application of physician impairment rating guides- The independent medical examination (IME): elements and reporting expectations- The role of the physician as an expert witness- Legal considerations- Ethical considerations