By Christopher Brigham

This week's tip is on "Combined Values". Most values in the Guides are combined, not added. A few points:

* The "Philosophy and Use of the Combined Values Chart" is presented in Section 1.4 on pages 9 and 10, and the Combined Values Chart appears on pages 604 through 606 (follow the directions). This philosophy is such that a region or part of body should never exceed the maximum value for the region or part of body. (ie. There can never be a person with greater than 100% WPI).

* The March/April 2002 issue of the Guides Newsletter featured an article on "Combining Values" explaining the rationale and practical aspects.

* Most impairments are combined, with the notable exception of: 1) range of motion deficits at the same joint, 2) range of motion deficits of the thumb, 3) total hand impairment (eg, hand impairment contributed to by each digit), and 4) rating hip or knee replacement results.

* Chapter 16, The Upper Extremities, on page 438 advises "If three or more values are to be combined, the two lowest values are first selected and their combined value is found. The combined value and the third value are then combined to give the total value." (However, in Calfornia, per the Permanent Disability Rating Schedule, the two largest numbers are first combined.)

* A common error with bilateral upper extremity impairment is combining at the upper extremity level. First, combine upper extremity impairments on one side and then convert to whole person. The whole person impairments from both sides are then combined.

* In California, per the directives of the Permanent Disablity Rating Schedule, specific impairments are converted to whole person for "adjustments" prior to combining the resultant disability rating.

* At www.impairment.com/tools there is a tool that will combine up to 3 values (easier than referencing the Combined Values Chart)

For on-demand AMA Guides training, go to www.guidesiq.com - your unique solution to learning the AMA Guides. For review of ratings and consultations, visit us at http://www.impairment.com .

Brigham is the editor of the Guides Newsletter and Guides Casebook. To view more of these tips visit:

www.impairment.com/tips

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