The information below is to provide a general over view concerning disability and impairment in Atlanta Georgia. Chiropractors who have complied with this chapter shall have the right to sign health certificates, reporting to the proper health officers the same as other practitioners.(GA Law)
Before I discuss the specifics of this case I would like to give some background information and definitions concerning causation. This information is not common knowledge and is important to understand. There are 3 main text books that I used for this information. The American Medical Association: Guides to the Evaluation of Permanent Impairment, fifth edition, the American Medical Association: Guides to the Evaluation of Permanent Impairment, sixth edition, the American Medical Association: Disability Evaluation, second edition. All 3 text books are widely accepted, peer reviewed and published by the American Medical Association.
Causation - An identifiable factor that results in a medically identifiable condition.
American Medical Association: Guides to the Evaluation of Permanent Impairment, fifth edition, page 600.
Cause – In general, anything that produces an effect. In medicine, cause refers to an identifiable factor that results in injury or illness. The cause or causes must be scientifically probable following causation analysis.
American Medical Association: Guides to the Evaluation of Permanent Impairment, sixth edition, page 610.
Reasonable Degree of Medical Certainty - Causal opinions in reports and testimony must be given in terms of reasonable medical probability or certainty. (more probably than not) Probability, simply means that something is more likely than not (51% or greater chance of occurring). If the confidence is equal to or less than 50% it is merely a possibility. Legal probability, then, simply means that something is more likely to occur than not.
Causality requires determination that each of the following has occurred to a reasonable degree of medical certainty:
• A causal event took place.
• The patient experiencing the event has the condition.
• The event could cause the condition.
• The event caused or materially contributed to the condition within medical probability.
American Medical Association: Guides to the Evaluation of Permanent Impairment, sixth edition, page 25.
A Causal Relationship is Biologically Plausible When:
1. The relationship between the medical condition and the exposure or injury can be explained anatomically or physiologically.
2. The duration, intensity, or mechanism or exposure or injury was sufficient to cause the illness or injury in questions.
3. There is evidence suggesting that the exposure is consistently or reliably associated with the process under investigation in the population under investigation or in peer-reviewed literature.
4. Cause and effect are contiguous - i.e., there is a readily understandable relationship between the two, in which an increase in the magnitude of the exposure reliably leads to an increase in the severity of its alleged effect upon the injured or exposed person, and vice versa.
5. There is literature providing biologic or statistical evidence indicating that the symptoms or disorder could develop as a result of the exposure (coherence).
6. There is specificity of the association for the injury (i.e., the absence of other factors, especially pre-existing disease that could have caused or contributed to the problem).
American Medical Association: Disability Evaluation, second edition, page 96
Criteria for Asserting the Existence of a Causal Relationship
Temporal Relationship- Cause should come before effect. The interval between the two should be consistent with what is found in reports or studies of similar exposures/injuries.
Mechanism- Must be anatomically and physiologically plausible.
Contiguity- Should be a clear relationship between cause and effect, with an
(Dose-Response/Duration)increase in exposure (dose or duration) leading to an increase in effect
Consistency- Exposure should consistently cause the disease or injury under investigation.
Specificity- Should be a relative absence of other factors or conditions which “explain” the disease.
Coherence- Presumption of work-relatedness in an individual case should be consistent with the medical literature.
American Medical Association: Disability Evaluation, second edition, page 25
On page 17 of the AMA Guides to the Evaluation of Permanent Impairment, fifth edition, it says that “if the clinical findings are fully described, any knowledgeable observer may check the findings with the Guides criteria.” It further states that, “any other observer or physician following the methods in the Guides to evaluate the same patient should report similar findings.”